How is depression diagnosed?

Dr. Jeanne Morrison, PhD
Family Practitioner

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.

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

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.

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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.