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

How does a doctor make a depression diagnosis?

We've become accustomed to doctors using specialized blood tests or other expensive laboratory tests to help them make a conclusive diagnosis. However, most laboratory tests are not very helpful when it comes to diagnosing depression. In fact, talking with the patient may be the most important diagnostic tool the doctor has.

To effectively diagnose and treat depression, the doctor must hear about specific signs and symptoms of 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 manifest in so many different ways. For example, some clinically depressed individuals seem to withdraw into a state of apathy. Others may become irritable or even agitated. Eating and sleeping patterns can be exaggerated. A depressed person may either sleep or eat to excess or almost eliminate those activities.

Observable or behavioral symptoms of clinical depression may be minimal despite a person experiencing profound inner turmoil. Depression is a pernicious and 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, personal interview, and lab tests. The doctor will also conduct a complete diagnostic evaluation, discussing any family history of depression. Your doctor will evaluate your symptoms, including how long you've had them, when they started, and how they were treated. Your doctor will ask questions about the way you feel, including whether you have any symptoms of depression such as the following:

persistently sad, anxious, or empty moods
loss of pleasure in usual activities (anhedonia)
feelings of helplessness, guilt, or worthlessness
crying, hopelessness, or persistent pessimism
fatigue or decreased energy
loss of memory, concentration, or decision-making capability
restlessness, irritability
sleep disturbances
change in appetite or weight
physical symptoms that defy diagnosis and do not respond to treatment (especially pain and gastrointestinal complaints)
thoughts of suicide or death, or suicide attempts
poor self-image or self-esteem (as illustrated, for example, by verbal self-reproach)