How do they test for depression

Depression Diagnosis and Screening: What Doctors Look For

Written by Debra Fulghum Bruce, PhD

How Does a Doctor Make a Depression Diagnosis?
What Does the Doctor Look for to Make a Depression Diagnosis?
How Can Depression Symptoms Lead to a Depression Diagnosis?
Are There Physical Signs of Depression?
Which Lab Tests Can Help Make the Depression Diagnosis?
How Can I Help the Doctor Make a Proper Diagnosis?
How Do I Know When to Seek Help?

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.

Depression Guide

Overview & Causes
Symptoms & Types
Diagnosis & Treatment
Recovering & Managing
Finding Help

Depression Tests -- Blood Tests, Screening, and Other Tests

Written by Debra Fulghum Bruce, PhD

If you are planning to see your doctor about depression, here is information about the kinds of tests your doctor might order. First, keep in mind that not every test is a "depression test." Some tests aren't used to diagnose clinical depression but rather to rule out other serious medical conditions that may cause similar symptoms.

In most cases, the doctor will do a physical exam and ask for specific lab tests to make sure your depression symptoms aren't related to a condition such as thyroid disease, vitamin D deficiency, or another medical problem. If your symptoms are related to another serious illness, treating that illness may also help ease the depression.

Diagnosing Depression and the Physical Exam

Again, the goal with a physical exam is usually to rule out another medical cause for depression. When performing the physical exam, the doctor may focus primarily on the neurological and endocrine systems. The doctor will try to identify any major health concerns that may be contributing to symptoms of clinical depression. For example, hypothyroidism -- caused by an underactive thyroid gland -- is the most common medical condition associated with depressive symptoms. Other endocrine disorders associated with depression include hyperthyroidism -- caused by an overactive thyroid -- and Cushing's disease -- a disorder of the adrenal gland.

Many central nervous system illnesses and injuries can also lead to depression. For example, depression might be associated with any of the following conditions:

Central nervous system tumors
Head trauma
Multiple sclerosis
Stroke
Syphilis
Various cancers (pancreas, prostate, breast)

Corticosteroid medications such as prednisone, which people take for diseases such as rheumatoid arthritis or asthma, are also associated with depression. Other drugs, including illegal steroids, excessive alcohol use, and amphetamines and over-the-counter appetite suppressants, may cause depression on withdrawal.

Diagnosing Depression and Lab Tests

Your doctor can usually tell if you have depression by asking you specific questions and doing a physical exam. Your doctor may, however, ask for lab tests to rule out other diagnoses. Your doctor will likely do blood tests to check for medical conditions that may cause depressive symptoms. They will use the blood tests to check for such things as anemia as well as thyroid or possibly other hormones, and sometimes calcium and vitamin D levels.

Diagnosing Depression and Other Testing Methods

The doctor may include other standard tests as part of the initial physical exam. Among them may be blood tests to check electrolytes, liver function, toxicology screening, and kidney function. Because the kidneys and liver are responsible for the elimination of depression medications, impairment to either of these two organs may cause the drugs to accumulate in the body.

Other tests may sometimes include:

CT scan or MRI of the brain to rule out serious illnesses such as a brain tumor
Electrocardiogram (ECG) to diagnose some heart problems
Electroencephalogram (EEG) to record electrical activity of the brain

Depression Screening Tests

After discussing your mood and the way it affects your life, your doctor may also ask you questions that are used specifically to screen for depression. It's important to keep in mind that the inventories and questionnaires the doctor may use are just one part of the medical process of diagnosing depression. These tests, however, can sometimes give your doctor better insight into your mood. They can use them to make a diagnosis with more certainty.

One example of a screening test is a two-part questionnaire that has been shown to be highly reliable in identifying the likelihood of depression. When you take this test, you will be asked to answer two questions:

During the past month, have you been bothered by feeling down, depressed, or hopeless?
During the past month, have you been bothered by little interest or pleasure in doing things?

Your answer to the two questions will determine what the doctor does next. The doctor may ask you additional questions to help confirm a diagnosis of depression. Or if your answers indicate you do not have depression, the doctor may review your symptoms again to continue the effort to find the cause. Studies show that these two questions, especially when used with another test as part of the assessment process, are highly effective tools for detecting most cases of depression.

Your doctor may use other depression screening instruments that measure the presence and severity of depression symptoms. Examples include:

The Patient Health Questionnaire-9 (PHQ-9) -- a 9-item self-administered diagnostic screening and severity tool based on current diagnostic criteria for major depression
Beck Depression Inventory (BDI), -- a 21-question multiple-choice self-report that measures the severity of depression symptoms and feelings
Zung Self-Rating Depression Scale -- a short survey that measures the level of depression, ranging from normal to severely depressed
Center for Epidemiologic Studies-Depression Scale (CES-D) -- an instrument that allows patients to evaluate their feelings, behavior, and outlook from the previous week
Hamilton Rating Scale for Depression (HRSD), also known as the Hamilton Depression Rating Scale (HDRS) or abbreviated to HAM-D -- a multiple choice questionnaire that doctors may use to rate the severity of a patient's depression

When you take a test or inventory, you may feel uncomfortable responding honestly to questions or statements that are made. The person who administers the test will be asking about depression and mood, depression and cognition, and the physical feelings of depression such as lack of energy, sleep disturbance, and sexual problems. Try to be as honest as you can when assessing your symptoms. Questionnaires and screening tools can help a mental health professional in making a diagnosis, but rating scales in themselves are not a substitute for a clinical diagnosis made from a thorough interview. Once your doctor has made an accurate diagnosis they can then prescribe an effective treatment.

If the Diagnosis Is Depression

Depression is treatable. Consequently, a depression diagnosis can start you on the road to a healthier life without feelings of helplessness, hopelessness, and worthlessness.

Once your doctor makes a depression diagnosis, you need to follow the treatment program to get better. It's important to take the medications as prescribed. You also need to follow through on making lifestyle changes and working with a psychotherapist if that's what your doctor recommends. Millions of people with depression suffer needlessly because they don't get professional help that starts with a doctor's diagnosis.

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Like blood pressure, cholesterol and blood glucose levels, mood should also be regularly monitored in primary care settings as it is a health risk factor in addition to its direct impact on well-being. If the general practitioner is committed to ensuring that the patient does not go undiagnosed, if there are funds in the clinic to meet the needs of patients (see regarding psychoeducation and/or psychotherapy), physicians could conduct routine screening for depression, for example, on all new patients. nine0003

There are many ways to test depression.

The WHO Quality of Life Questionnaire (WHO-5) can be used as a first line screening for depression. This is a high specificity test for depression in primary care settings. It's easy to use and short, with only five points, framed positively (no explicit mention of depression). If the patient's score is less than or equal to 13, then they may be having a depressive episode (80% sensitivity). In these patients, a general practitioner should conduct additional diagnostics. nine0003

Reference: WHO-5.

Another screening tool for use in primary care is the Health Status Questionnaire (PHQ-9), which allows the general practitioner to determine the severity of depressive symptoms and the degree of functional impairment. This method also has high specificity and is sensitive to changes over time. A score of 5-9 suggests mild depression, 10-14 suggests moderate depression, and more than 15 indicates severe depression. Particular attention should be paid to affirmative answers to paragraph 9("thinking that it would be better to die or harm yourself in some way").

Reference: PHQ-9.

There are two most important problems in diagnosing depression:

to distinguish it from "feeling down", that is, from normal or transient depressive feelings;
does not underestimate even mild symptoms of depression, which may be treatable.

There are several elements of a depressive episode that indicate that it is serious, such as apathy, emotional numbness, guilt, severe hopelessness, diurnal mood swings, psychotic symptoms, and personality changes. nine0003

Differential Diagnosis

When making a diagnosis of depression, mood disorders due to organic causes should also be considered. Somatic and/or iatrogenic depressions should be excluded and treated:

endocrinological dysfunction such as hyper- or hypothyroidism, hyperparathyroidism, hypercortisolism;
neurological disorders;
viral infections;
cancerous and paraneoplastic syndromes; nine0018
autoimmune reactions;
pharmacological causes such as corticosteroid therapy, benzodiazepine abuse and dependence, etc.

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"Depression should be treated by psychiatrists": three signs of illness and how to avoid it

April 7, 2017, 07:48

More than 300 million people in the world today are living with depression. Therefore, it is not surprising that the theme of World Health Day, which is celebrated on April 7, is depression.

According to the World Health Organization (WHO), depression is one of the leading causes of ill health and disability worldwide. In the 10 years from 2005 to 2015, the number of people with depression increased by more than 18%. "Because of a lack of support, many people with mental disorders do not seek the treatment they need to live healthy and productive lives," the organization said. The WHO is urging countries to increase investment in mental health, reminding that even in high-income countries, about 50% of people with depression do not receive treatment. nine0003

Meanwhile, most depressions are treated on an outpatient basis, if the patient turns to a psychiatrist for help in time. This was told to TASS by the chief freelance specialist of the Ministry of Health of the Russian Federation in psychiatry, director of the State Scientific Institute of Forensic and Social Psychiatry. V.P. Serbian Zurab Kekelidze. “Of course, there are chronic, resistant severe conditions when serious measures must be taken,” the expert added.

From 3.7% of the population to 6.5% in different countries - the percentage of people diagnosed with depression. Russia is in the middle of this list - we have about 5.5%

Kekelidze notes that, according to statistics, there are more women diagnosed with depression. However, this may be partly due not to a predisposition to depression, but to the fact that women are more attentive to their health. “They notice deviations faster, see a doctor more often and are more attentively treated,” he said.

Three signs of depression

See also0002 The chief specialist of the Ministry of Health of the Russian Federation in psychiatry notes that a bad mood is not only from real external causes, but also from a disease called "depression".

"Three main signs are standardly distinguished: a feeling of low mood, motor (motor) retardation, idiotic retardation (when a person feels that it has become harder for him to think, to choose words more slowly, a feeling that he is not thinking about anything)," Kekelidze explained .

In addition to the main signs of depression, there are many varieties: masked (mild depression), seasonal, postpartum, depression that accompanies other somatic conditions - Alzheimer's disease, hypothyroidism and many others. nine0003

The psychiatrist advises parents to take a closer look at changes in the child's behavior: sleep disturbances, changes in appetite (stopped eating or eats a lot of sweets) can be early signs of depression.

What prevents Russians from treating depression

In Russia, according to Kekelidze, the problem that not all people with depression receive the necessary treatment is due to the lack of habit of taking care of their health preventively, as well as the fact that people in Russia still For the time being, they are afraid of neuropsychiatric dispensaries, where they try not to go unless absolutely necessary. Not the last role is played by the stigmatization of mental illness - hence the fear of turning to a psychiatrist for help. nine0003

However, according to the expert, one should not hope that depression will go away on its own. It is a disease, and like any disease, it must be dealt with by a medical specialist.

Depression should be treated by psychiatrists or psychotherapists. But most people do not go to doctors, they are afraid that they will register

The psychiatrist noted that not every patient needs to be registered with a dispensary, and there are a number of criteria for this. The basis is a danger to oneself and others.

According to the expert, depression is characterized by lack of will, so the worst thing you can advise a depressed person is to tell him "get it together", "pull yourself together." A professional psychiatrist or psychotherapist should say this to the patient, because otherwise the feeling of guilt for "not being able to pull himself together" will grow. nine0003