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 to diagnose some heart problems
- Electroencephalogram to record electrical activity of the brain
Medication And Older Adults
As you get older, body changes can affect the way medicines are absorbed and used. Because of these changes, there can be a larger risk of drug interactions among older adults. Share information about all medications and supplements youre taking with your doctor or pharmacist.
Use this worksheet to help track your medications.
Treatment, particularly a combination of psychotherapy and medications, has been shown to be effective for older adults. However, not all medications or therapies will be right for everyone. Treatment choices differ for each person, and sometimes multiple treatments must be tried in order to find one that works. It is important to tell your doctor if your current treatment plan isnt working and to keep trying to find something that does.
Some people may try complementary health approaches, like yoga, to improve well-being and cope with stress. However, there is little evidence to suggest that these approaches, on their own, can successfully treat depression. While they can be used in combination with other treatments prescribed by a persons doctor, they should not replace medical treatment. Talk with your doctor about what treatment might be good to try.
Dont avoid getting help because you dont know how much treatment will cost. Treatment for depression is usually covered by private insurance and Medicare. Also, some community mental health centers may offer treatment based on a persons ability to pay.
New Mood Disorders Added
One major area of change in the DSM-5 was the addition of two new depressive disorders: disruptive mood dysregulation disorder and premenstrual dysphoric disorder .
The diagnosis of DMDD is reserved for children between the ages of 6 and 18 who demonstrate persistent irritability and frequent episodes of out-of-control behavior. The age of onset must be before the age of 10. The diagnosis was added to address concerns that bipolar disorder in children was being overdiagnosed.
PMDD is a more severe form of premenstrual syndrome . The conditions are characterized by intense depression, anxiety, moodiness, and irritability related to the hormonal fluctuations throughout the menstrual cycle.
PMDD previously appeared in Appendix B of the DSM-IV under “Criteria Sets and Axes Provided for Further Study.” In the DSM-5, PMDD appears in the depressive disorders section.
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Why So Many Questions During Diagnosis
Even though sadness and depression are different, grief can trigger depression, so healthcare providers need to be able to drill down to make a diagnosis. This is important because the medical care necessary for depression, a serious mental health condition, differs from that necessary to manage grief.
Which is why healthcare providers, if they suspect the possibility of depression, often will use a diagnostic tool like a depression rating scale. They use the scale to determine whether your symptoms are indicative of depression and, if they are, the severity of the symptoms.
One of the most commonly used diagnostic tools is theHamilton Rating Scale for Depression-17 (HAM-D-17. It focuses on 17 potential factors of depression related to mood, behavior, and symptoms. Your healthcare provider will complete the questionnaire based on how youve experienced or not experienced each factor during the past week.
Some of the questions your healthcare provider might ask include:
- Do you have a depressed mood ?
- Do you experience feelings of guilt?
- Do you have thoughts of suicide?
- Do you have insomnia early in the night? In the middle of the night? Early hours of the morning?
- Do you have trouble working?
After your healthcare provider has completed scoring for each item, they will tally your score. Then they will determine the severity of your depression using the HAM-D17 depression severity rating scale:
- 0-7: No Depression
- 24+: Severe Depression
Rule Out Other Conditions
If you identify with the symptoms of depression, your next step should be a visit to your family doctor or general practitioner for a thorough exam and screening. Your provider will ask you about your health history and risk factors and may use written questionnaires to assess your symptoms.
Your family doctor or general practitioner will also want to rule out several medical conditions that can contribute to symptoms of depression, such as vitamin and mineral deficiencies, female hormonal changes, and thyroid conditions. In addition, several medications may have depressive symptoms as a side effect.
If your general practitioner doesn’t find any of these factors as a cause of your depression, they may prescribe an antidepressant or refer you to a mental health professional, such as a psychiatrist, psychologist, or counselor.
In 2017, an estimated 17.3 million adults in the United States experienced at least one episode of severe depression, or 7.1% of all adults. For adolescents between the ages of 12 and 17 years old, the percentage is even higher, with an estimated 3.2 million adolescents in the U.S. experiencing at least one major depressive episode in a year.
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How Is Depression Syndrome Diagnosed
Everyone may feel sad or down from time to time. However, clinical depression has more intense symptoms that last two weeks or longer.
To determine whether you have clinical depression, your healthcare provider will ask questions. You may complete a questionnaire and provide a family history. Your healthcare provider may also perform an exam or order lab tests to see if you have another medical condition.
Aim To Get A Good Nights Sleep
Not enough sleep can worsen symptoms of both anxiety and depression but too much sleep can also affect well-being and mood.
Experts recommend most adults get
These tips can help you get the sleep you need:
- Make a habit of going to bed and getting up around the same time each day.
- Turn off electronic devices about 1 hour before bedtime.
- Create a soothing ritual that helps you wind down before bed.
- Keep your bedroom dark, cool, and quiet.
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How Do You Know If You Have Both
Think about how you feel after social interactions. Do you feel good about yourself or bad about yourself?
Keep in mind that everyone deals with awkward social interactions from time to time. How you handle and cope with these interactions can determine whether youre dealing with mental health challenges.
A person who doesnt have social anxiety can usually brush off an awkward social moment and move on.
For someone living with social anxiety, however, the fear of embarrassment and genuine anxiety may feel too intense to even deal with a social situation. If you do find yourself in a social setting, you may feel like youre being watched and judged the whole time.
If you suspect youre dealing with symptoms of social anxiety, depression, or both, try to talk with a doctor or mental health expert. They can help you understand your symptoms and point you toward the best type of treatment.
Treatments are available to improve social anxiety and depression. If youre diagnosed with both, your doctor may choose a therapy that works for both conditions.
What Are The Complications Of Depression
When depression becomes very severe, dark thoughts can emerge and these can even lead to suicide. If you are having thoughts of suicide, talking to someone you trust can help.
If someone you care about has severe depression, learn the warning signs, since they may be feeling so bad that they cant see their way out alone.
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Depression Can Look Different Depending On A Persons Cultural Background
Signs and symptoms of depression can look different depending on the person and their cultural background. People from different cultures may express emotions, moods, and mood disorders including depression in different ways. In some cultures, depression may be displayed as physical symptoms, such as aches or pains, headaches, cramps, or digestive problems.
Activity: Working Through Itthinking About Your Diagnosis
Writing your thoughts, concerns, questions and goals down can be a very helpful tool to help you make sense of your diagnosis and next steps. Working it out by writing can also help you describe what you’re going through to loved ones or health professionals. Also, if you need to access different services and supports, various professionals may start to ask you about your diagnosis including who provided the diagnosis and when it happened. Writing things down can help you remember what youve been told. If you add your thoughts and concerns too, writing can help you see your own progress over time in your recovery journey.
Step 1
Before you can be expected to deal with your diagnosis, you need to be able to put your diagnosis into words. Answer the following questions in your journal:
What diagnosis were you given?
Who provided you with the diagnosis?
When was it given to you ?
Did anyone else confirm this diagnosis? When?
What investigations were done to arrive at the diagnosis?
In lay words, what does this diagnosis mean? What does it involve?
What questions did you ask after you were given the confirmed diagnosis? If you can remember, what answers were you given for your questions?
How much did you already know about depression? Little? Some? A lot?
What attitudes and assumptions did you have about people with depression before this?
How much do you accept this diagnosis? Fully, Unsure, Dont accept it?
How much does it make sense with what you were experiencing?
Step 2
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What Might The Outcome Of My Appointment Be
The outcome of your appointment will usually depend on:
- what you say
- what your doctor thinks might help
- what kind of support you would like.
For example, your doctor might suggest one or more of the following options:
- Monitoring your doctor might ask you to come back for another appointment before offering any treatment.
- Diagnosis your doctor might give you a diagnosis, for example of depression or anxiety. This doesn’t always happen after your first appointment and may only be possible after monitoring you over time or referring you to a specialist.
- Lifestyle changes your doctor may suggest that making small changes to your exercise, eating and sleep habits may help you to manage your symptoms.
- Referral your doctor could refer you to another service, such as talking therapies .
- Self-referral your doctor could give you details of a service you can contact yourself, for example psychological wellbeing services or a community mental health team .
- Medication your doctor might offer to prescribe you psychiatric medication. If they do this they should should clearly explain what it’s for and explain any possible risks and benefits, so you can make an informed choice about whether or not you want to take it.
If you drive, you might have to tell the Driver and Vehicle Licencing Agency if you’re diagnosed with a mental health problem.
Whats The Difference Between Depression And Anxiety
Anxiety and depression are distinct mental health disorders. Each has its own set of symptoms.
For example, someone with anxiety may experience excessive fear or worry, while someone with depression may experience persistent feelings of hopelessness.
However, they are often interconnected. Someone with depression can experience anxiety symptoms as part of their mood disorder, and someone with a persistent anxiety disorder can develop depression over time.
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How Can My Healthcare Provider Tell Whether I Am Sad Or Depressed
Throughout life, people face many situations that result in feelings of sadness or grief: death of a loved one, loss of a job, or the ending of a relationship. Your healthcare provider, during your appointment, will likely have an unstructured conversation with you to figure out whether you might be clinically depressed or whether you are struggling with a temporary sadness that is not depression.
While depression shares some characteristics with grief and sadness, they are not the same. Typically, people experiencing grief will feel overwhelming sad feelings in waves, according to the American Psychiatric Association. In the case of grief, self-esteem is usually maintained.
With Major Depressive Disorder , the painful emotions tend to persist without much relief and often are paired with feelings of worthlessness and self-loathing. The National Institutes of Health writes that Major Depressive Disorder causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. These symptoms must be present for at least two weeks in order to be diagnosed with depression.
Do I Need To See A Doctor
Every mental illness has its own list of symptoms. But there are common ones that could be a red flag that something is wrong. These include:
- Loss of appetite.
- Thinking negative thoughts about yourself.
- Frequently feeling anxious or worrying a lot.
- Irritability or moodiness.
- Not enjoying life as much as you used to.
- Finding day-to-day life difficult .
- Trouble sleeping or sleeping too much.
- Seeing or hearing things that arent there.
If you have noticed any of these changes over the last few weeks or months, you should consider making an appointment with your family doctor.
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See A Mental Health Professional
If your doctor diagnoses you with depression, you may then be referred to a mental health professional, such as a psychiatrist. The psychiatrist will further evaluate your mood and determine whether or not medication is needed.
Some people will do fine being treated by their primary care physician. Others may benefit from seeing a psychiatrist, especially if symptoms are not improving with the first trial of an antidepressant or the depression is severe from the start.
Research suggests that the combination of medication and therapy is most effective for treating depression. If you would benefit from psychotherapy, your psychiatrist may handle this as well, although some elect to refer patients to another mental health professional, like a psychologist.
Consider Seeing A Psychiatrist First
There’s a tendency for some new patients to visit a counselor or psychologist for their initial mental health evaluation rather than a psychiatrist. This can be beneficial for many people, especially if your case is not severe, but for others, it’s often not enough.
Only psychiatrists are also medical doctors, which means that they are able to prescribe medications.
If your depression stems from a chemical imbalance, talk therapy will not be sufficient to treat you. It’s best to make your initial visit to a psychiatrist, who can both prescribe medications and offer you psychotherapy if it’s needed. This two-pronged approach of medication and talk therapy is often the most beneficial to patients.
Psychotherapy is a broad term for a variety of different verbal and psychological techniques that are employed to help an individual work through their mental health condition or source of underlying stress. These techniques include but are not limited to psychoanalytic therapy or psychodynamic psychotherapy, behavior therapy, cognitive therapy, and cognitive behavioral therapy . Oftentimes, other mental health professionals in the field such as counselors and social workers will draw from psychotherapeutic techniques and use them with their clients.
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Questions To Ask Yourself
Again, its very common to feel low or sad, stressed or anxious, or any combination of the above, on occasion.
All the same, youre the best person to recognize whats typical for you. If you start to experience new, uncomfortable feelings, changes in your energy and motivation, or any other unusual symptoms, it never hurts to connect with a mental health professional for more guidance.
You might wonder whether an online self-test for anxiety or depression could offer more insight about the changes youve noticed. Some people do find these a helpful place to start but a more personalized route might involve asking yourself a few questions:
- Do I spend a lot more time worrying than I have in the past?
- Do I feel sad, empty, or hopeless often?
- Have I lost interest in the things I used to enjoy?
- Have I started to avoid spending time with friends and loved ones?
- Do I worry about things I cant control to the point where I have a hard time thinking about anything else?
- Do I become irritable or annoyed more quickly than I have in the past?
- Do I often feel restless, on edge, or unable to relax?
- Do I cycle through dark, unwanted, or fearful thoughts I cant seem to stop?
- Is it difficult to fall asleep, get enough sleep, or wake up on time most days?
- Have I noticed unexplained pain, tension, or other physical symptoms?
- Do these changes affect my daily life or relationships?
If you answered yes to most of the questions above, it may be time to reach out to a therapist.
New Tools For Assessing Suicide Risk
The DSM-5 does include new scales for assessing suicide risk: one for adults and one for adolescents. These scales are intended to help clinicians identify suicide risk in patients as they are developing treatment plans.
If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see our National Helpline Database.
The tools are included in the new Section III of the DSM-5 and are intended to better support clinicians in identifying risk factors for suicide as well as scales for assessing suicidal behaviors .
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