How is depression diagnosed?

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For a diagnosis of major depression to be made, an individual must exhibit five or more of the following symptoms during the same two-week period:

  • persistent sad, anxious, or empty mood
  • loss of interest in activities once previously enjoyed
  • excessive crying
  • increased restlessness and irritability
  • decreased ability to concentrate and make decisions
  • decreased energy
  • thoughts of death or suicide, or suicide attempts
  • increased feelings of guilt, helplessness, and/or hopelessness
  • weight and/or appetite changes due to over-or under-eating
  • changes in sleep patterns
  • social withdrawal
  • physical symptoms unrealized by standard treatment (i.e., chronic pain, headaches)

The symptoms of major depression may resemble other psychiatric conditions. Always consult your physician for a diagnosis.

Deborah Davis, DNP
OBGYN (Obstetrician & Gynecologist)

A diagnosis of depression requires a complete physical and psychological evaluation.  The examining physician must first rule out other causes of depression; some medications and medical conditions can cause symptoms of depression.  Many doctors use screening tools, symptom tests, for depression, which are usually questionnaires that help identify people who have symptoms of depression and may need to receive a full mental health evaluation.  A thorough diagnostic evaluation includes a complete history of the patient's symptoms and a mental-status examination.  This evaluation can usually be accomplished during the initial office visit.

Not everyone who suffers from depression experiences the same symptoms or the same level of severity. Generally, a diagnosis requires that five or more of the following symptoms must be present for two weeks.

  • Persistent sadness
  • A loss of interest in normal activities
  • Increased irritability and restlessness
  • Feelings of hopelessness, guilt, worthlessness and helplessness
  • Fatigue, weight loss or weight gain, lethargy and changes in eating or sleeping habits
  • Difficulty concentrating, forgetfulness and indecision
  • Suicidal thoughts or attempts, self-mutilation
  • Persistent pain - such as headaches, stomachaches and digestive problems - that do not respond to treatment
  • Worsened existing conditions, such as arthritis or diabetes
Donna Hill Howes, RN
Family Practitioner

To diagnose depression, a doctor will perform a physical exam and take your personal and family medical history. Your doctor will ask about your symptoms and may run lab tests to rule out more serious problems. Then your doctor may ask you to answer a standardized questionnaires that can help identify depression and determine its severity. The Hamilton Depression Rating Scale is conducted verbally by a doctor or therapist. The Beck Depression Inventory is a test you take alone. While no test can confirm depression, your doctor will rule out other medical problems and focus on your thoughts and feelings. If you have felt suicidal, tell your doctor. Also, if you have severe sleep problems, your doctor may recommend a sleep test (polysomnography), which may help determine whether you have a sleep disorder or a mood disorder. 

Chronic, relentless depression—whether severe or mild—calls for extra steps to ease symptoms. Don't try to manage your moods on your own if for two weeks or longer you have any of the following symptoms:

  • Trouble concentrating
  • No zest for life
  • Trouble sleeping
  • Sleep too much
  • Sudden weight loss or weight gain

Clinical depression is a physical ailment, not a matter of attitude. As with any illness, the smart move is to get the best care possible. Talk to a doctor about getting therapy and medical treatment.

Dr. Jeffrey Gardere, PhD
Psychology Specialist

You should seek treatment for depression if you experience symptoms like extreme sadness or major changes in functioning for at least two weeks. Watch psychologist Jeffrey Gardere, PhD, explain when it's time to see a doctor for depression.

Dr. Sanam Hafeez, PsyD
Psychology Specialist

The signs of depression are sometimes subtle, so you need to be aware of small changes in your life and mood. In this video, neuropsychologist Sanam Hafeez, PsyD, shares tips for knowing when you may want to seek treatment for depression symptoms. 

Dr. John Preston, PsyD
Psychology Specialist

With depression, the most important first step is to get an accurate diagnosis. Note that certain physical health conditions can cause feelings of sadness, lethargy, and lack of motivation, so it’s important to first make sure that what you’re experiencing is, in fact, depression. If you have a medical doctor you see regularly, he or she can rule out any medical conditions and can screen you for depression or other common mental health issues. Since depression is so common, many general practitioners and family practice doctors now screen patients for depression as a normal part of any health checkup. Your doctor can then give you a referral to a psychotherapist or support group and to other resources you can go to for help. 

You can also seek out a psychiatrist, who can prescribe medications for your depression if you both decide that’s the best option. A clinical psychologist or licensed therapist is also qualified to make a diagnosis of depres- sion. All of these health care professionals can then help you decide the best way to begin treatment.

Depression 101: A Practical Guide to Treatments, Self-Help Strategies, and Preventing Relapse

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Depression 101: A Practical Guide to Treatments, Self-Help Strategies, and Preventing Relapse

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Your primary care provider may diagnosis you with depression or some other mental health illness and offer treatment, which could be antidepressants, psychotherapy (counseling) or both. Or your primary care provider may refer you to a mental health professional for diagnosis and treatment. In all cases, your primary care provider should follow up to see that you're getting the care you need. That can be as simple as a phone call or a return visit.

A recommendation from the U.S. Preventive Services Task Force (USPSTF) says that primary care providers should screen all adults, including pregnant and postpartum women, with "adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up."

Mild-to-moderate depression—termed dysthymic disorder, or dysthymia—is marked by milder symptoms than major depression, but the symptoms are prolonged and protracted.

Dysthymia is characterized by depressed mood for most of the day, on more days than not, for at least two years. Additionally, a diagnosis of dysthymia requires the presence of at least two of these symptoms while depressed:

  • poor appetite or overeating
  • trouble sleeping or sleeping too much
  • fatigue, loss of energy or tired all the time
  • low self-esteem
  • impaired concentration and difficulty making decisions
  • feelings of hopelessness and helplessness

To be considered as indicative of dysthymia, the first two years of depressed mood cannot include any episodes of major depression. Furthermore, diagnosis of dysthymia precludes a history of manic episodes and requires that depressed mood occur not during the course of some other psychiatric disorder such as schizophrenia. In addition, no underlying cause of depressed mood, such as a general (i.e., other than psychiatric) medical condition or substance abuse, must be present.

The symptoms of dysthymia cause significant distress or impairment in social, occupational, and other important areas of functioning.

Depression is diagnosed clinically by your primary care physician, who may be a family doctor, internal medicine doctor or obstetrician/gynecologist. In addition, depression may be diagnosed by a therapist, psychologist or psychiatrist. It is important to go to a doctor because sometimes another medical condition could be causing many of the same symptoms as depression, such as a change in eating habits, lack of energy and lack of interest in previously enjoyable activities. A doctor will get a complete medical history, do a physical examination, possibly order laboratory tests, and determine if the patient has depression or some other medical condition.

 

Doctors use a set of symptoms or criteria to measure if someone meets the diagnosis of having major depression. A patient who has five or more of the following symptoms nearly every day for at least two weeks may meet the criteria. The symptoms include:

  • depressed mood
  • loss of interest or pleasure in activities
  • sleep problems
  • change in appetite
  • psychomotor changes (agitated or lethargic movements)
  • low energy
  • poor concentration
  • excessive guilt or sense of worthlessness
  • suicidal thoughts

A psychiatrist or trained medical professional diagnoses depression based on a patient’s history and presentation of illness. According to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, the diagnosis of major depressive disorder includes symptoms related to changes in mood, interest, energy, concentration, sleep, appetite, and thoughts of death or suicide. There are currently no laboratory tests that establish the diagnosis of depression.

Doctors use several different tools to diagnose depression:

  • Questionnaires - Your doctor may use questionnaires (forms) to check for depression and other mental health problems. The questionnaires ask about your symptoms. They may also ask about stress, your coping style, and the support you have in your life.
  • Medical history - Your doctor will ask about your past and present illnesses and your family's health history.
  • Physical exam - An exam will help your doctor know if your symptoms come from something other than depression.
  • Diagnostic criteria - To make a diagnosis, your doctor will compare your information to standard medical definitions for mental health disorders.

Because depression is a "whole-body" disorder, both a general physical and a psychiatric evaluation are recommended. The physical can identify or rule out other causes for the symptoms and may help to determine your fitness to undergo treatment for depression. The psychiatric evaluation can help to establish the problem's intensity and to detect any other emotional disorders that may be present.

Although the term “depression” is often used casually to refer to a sad or low mood state, in psychiatry, the term “Major Depressive Disorder” refers to a specific illness that is characterized by one or more “major depressive episodes.” A major depressive episode is defined very strictly as a period of at least 2 weeks, during which 5 or more of the following symptoms have been present:

  • sad mood
  • decreased interest or pleasure in most activities
  • change in appetite (often with weight loss or weight gain)
  • sleep disturbance
  • slowed or agitated movements and thinking
  • loss of energy or fatigue
  • feelings of worthlessness or guilt
  • difficulty concentrating
  • recurrent thoughts of death or desire to die

At least one of the symptoms must be a sad mood or loss of interest or pleasure. The symptoms must represent a change from previous functioning and cause significant impairment in one’s ability to function in areas such as social relationships or job performance. It is important to treat depression because untreated depression may be associated with a number of complications, including relationship problems, missed days from work, poor physical health, and, when most severe, suicide. There are many good treatment options for depression that allow affected individuals to live normal, happy, and productive lives. There are also many psychiatric conditions that be confused with major depressive disorder, as well as many prescription medications, illicit substances, and medical conditions, which can cause similar symptoms but have different treatments. It is therefore important to speak with your primary care physician or psychiatrist if you are experiencing any of the symptoms of a depressive episode.

Depression can actually be a symptom of other conditions, so if you're exhibiting symptoms of depression, your doctor may first conduct a physical exam or do blood tests to rule out other causes. You will probably be questioned about your symptoms, both physical and emotional, which a doctor will use as part of a psychological evaluation. During this interview, your doctor will likely also be trying to determine if your symptoms are indicative of a different psychological disorder like dysthymia (mild, long-term depression) or bipolar disorder. In addition, they will ask you about your family history and any medications you are taking that could affect your mood.

Generally, the compilation of all this information will give your doctor enough information to compare your symptoms to the criteria for depression listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). If you have more than five symptoms on their list for over two weeks, you may be diagnosed with depression. There is no test that can diagnose depression with 100 percent certainty, but the DSM is usually considered a reliable measure for diagnosis.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.