Depression Diagnosis

It used to be that all mood disorders were lumped together. Now, a doctor will make a distinction about the particular disorder or subtype of depression that a patient has. For example, a doctor will determine whether a patient has major depression, chronic depression including dysthymia, seasonal affective disorder (SAD), bipolar disorder, or some other type of clinical depression.

It can be hard to talk to your doctor if you think you might be depressed. You may feel embarrassed or isolated. But you’re not as alone as you might think. About 1 in 5 people will have some sort of mental illness in their lifetime.

In addition, depression rarely goes away by itself and may even get worse without treatment. So it’s important to reach out when you notice symptoms. Your primary care doctor is a good place to start. They’ll be able to help you sift through your symptoms and perhaps refer you to a mental health expert like a psychologist, psychiatrist, or a therapist who can help you further.

How Does a Doctor Make a Depression Diagnosis?

We've gotten used to doctors using special blood tests or other complex laboratory tests to help them make a conclusive diagnosis. But most lab tests aren’t very helpful when it comes to diagnosing depression. In fact, talking with the patient may be the most important diagnostic tool the doctor has. The recommendation is that doctors routinely screen everyone for depression. This screening might take place during a visit for a chronic illness, at an annual wellness visit, or during a pregnancy or postpartum visit.

To effectively diagnose and treat depression, the doctor must hear about specific symptoms of depression. They may use a series of standard questions to screen for depression. While a physical examination will reveal a patient's overall state of health, by talking with a patient, a doctor can learn about other things that are relevant to making a depression diagnosis. A patient, for example, can report on such things as daily moods, behaviors, and lifestyle habits.

A depression diagnosis is often difficult to make because clinical depression can show up in so many different ways. For example, some clinically depressed people seem to withdraw into a state of apathy. Others may become irritable or even agitated. Eating and sleeping patterns can be exaggerated. Clinical depression may cause someone to sleep or eat to excess, or almost eliminate those activities.

Observable or behavioral symptoms of clinical depression also may sometimes be minimal despite profound inner turmoil. Depression can be an all-encompassing disorder, and it affects a person's body, feelings, thoughts, and behaviors in varying ways.

What Does the Doctor Look for to Make a Depression Diagnosis?

A doctor can rule out other conditions that may cause depression with a physical examination, a personal interview, and lab tests. The doctor will also do a complete diagnostic evaluation, discussing any family history of depression or other mental illness.

Your doctor will evaluate your symptoms, including how long you've had them, when they started, and how they were treated. They’ll ask about the way you feel, including whether you have any symptoms of depression such as:

• Sadness or depressed mood most of the day or almost every day
• Loss of enjoyment in things that were once pleasurable
• Major change in weight (gain or loss of more than 5% of weight within a month) or appetite
• Insomnia or excessive sleep almost every day
• Physical restlessness or sense of being run-down that others can notice
• Fatigue or loss of energy almost every day
• Feelings of hopelessness or worthlessness or excessive guilt almost every day
• Problems with concentration or making decisions almost every day
• Recurring thoughts of death or suicide, suicide plan, or suicide attempt

How Can Depression Symptoms Lead to a Depression Diagnosis?

To be diagnosed with major depression, you must have at least five of the symptoms listed above with at least one of the first two nearly daily for at least 2 weeks.

Depression symptoms can last weeks, months, or sometimes years. They can affect personality and interfere with social relationships and work habits, potentially making it difficult for others to have empathy for you. Some symptoms are so disabling that they interfere significantly with your ability to function. In very severe cases, people with depression may be unable to eat, maintain their hygiene, or even get out of bed.

Episodes may happen only once in a lifetime or may be recurrent, chronic, or longstanding. In some cases, they seem to last forever. Symptoms may appear to be precipitated by life crises. At other times, they may seem to happen at random.

Clinical depression commonly goes along with other medical illnesses such as heart disease or cancer and worsens the prognosis for these illnesses.

Are There Physical Signs of Depression?

Yes. In fact, a great many people with depression come to their doctor first with only physical issues. You might notice:

• Back pain
• Headaches
• Joint pain
• Limb pain
• Gut problems (digestion issues and belly pain)
• Constant tiredness
• Sleep problems
• Slowing of physical movement and thinking

You might notice these symptoms and signs even before you notice the mental health symptoms of depression, or you might notice them at the same time. Your doctor can help you figure out the source of your symptoms.

Which Lab Tests Can Help Make the Depression Diagnosis?

After reviewing the information from your appointment, including the signs and symptoms, patient history, family history, and physician exam, your doctor may ask for some lab tests to rule out a physical condition that may be causing your symptoms. Certain viruses, medicines, hormonal or vitamin deficiencies, and illnesses can cause depression-like symptoms. Your doctor will also want to review all medications you’re taking as well as the alcohol or recreational drugs you may be using.

How Can I Help the Doctor Make a Proper Diagnosis?

Before your appointment, write down your concerns about depression and specific symptoms of depression you might have. It’s also helpful to get an in-depth family history from relatives before meeting with your doctor. This information can help the doctor make an accurate diagnosis and ensure effective treatment. Before your visit, think about and write down:

• Your mental and physical health concerns
• Symptoms you've noticed
• Unusual behaviors you've had
• Past illnesses
• Your family history of depression
• Medications you’re taking now and in the past, including both prescribed and over-the- counter medications
• Unusual side effects of medications you are taking or have taken
• Natural dietary supplements you’re taking
• Your lifestyle habits (exercise, diet, smoking, alcohol consumption, drug use)
• Your sleep habits
• Causes of stress in your life (marriage, work, social)
• Questions you have about depression and depression medications

How Do I Know When to Seek Help?

The biggest hurdle to diagnosing and treating depression is recognizing that someone has it. Unfortunately, about half of the people who have depression never get diagnosed or treated. And not getting treatment can be life threatening: More than 10% of people who have depression take their own lives.

• When depression is hurting your life, such as causing trouble with relationships, work issues, or family disputes, and there isn't a clear solution to these problems, you should seek help to keep things from getting worse, especially if these feelings last for any length of time.
• If you or someone you know is having suicidal thoughts or feelings, seek help right away.

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