It used to be that all mood disorders were lumped together. Now, however, a doctor will make a distinction regarding 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 (a mild form of just a few longstanding depression symptoms), 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 extensive 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. The recommendation is that doctors routinely screen all individuals for depression. This screening might occur 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. A doctor may use a series of standard questions to screen for depression. While aphysical 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. Clinical depression may cause a person either to sleep or eat to excess or almost eliminate those activities.
Observable or behavioral symptoms of clinical depression also may sometimes be minimal despite a person experiencing 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, personal interview, and lab tests. The doctor will also conduct 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. Your doctor will ask questions about the way you feel, including whether you have any symptoms of depression such as the following:
- 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 rundown that is noticeable by others
- 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 two weeks.
Depression symptoms can last for weeks, months or sometimes even 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 occur 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 occur at random.
Are there physical signs of depression?
There are no inevitable physical signs of depression, though some manifestations may be seen quite often. Signs of depression may include the following:
- Appearance of preoccupation
- Lack of eye contact
- Memory loss, poor concentration, and poor abstract reasoning
- Pacing, hand wringing, and pulling on hair
- Psychomotor retardation or agitation, such as slowed speech, sighs, and long pauses
- Self-deprecatory manner, or belligerence and defiance (especially in adolescents)
- Slowed body movements, even to the extent of being motionlessness or catatonic
- Tearfulness or sad countenance
What lab tests can help make the depression diagnosis?
After reviewing the information given at 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. For example, hypothyroidism could also cause symptoms of depression. Your doctor will also want to review all medications you are 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 doctor's appointment, write down a list of concerns you may have about depression and specific symptoms of depression you might have. It is also helpful to get an in-depth family history from relatives before meeting with your doctor. This key information can help the doctor make an accurate diagnosis and ensure effective treatment. Before your visit, consider and record the following:
- Your mental and physical health concerns
- Symptoms you've noticed
- Unusual behaviors you've had
- Past illnesses
- Your family history of depression
- Medications you are 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 are 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