Diagnosing depression – uncovering the facts and fears

by Martin

in Depression Diagnosis

Diagnosing depression is the first step toward treating depression. So, diagnosis is an important point on any sufferer’s path towards coping with and recovering from depression.

Here I look at some of the fears and facts associated with depression diagnosis.

Are you scared about being diagnosed with depression?

Although it may be fairly self-evident that until your condition is diagnosed you will not be able to access help through the professional health care system, you may still feel as if you do not wish to consult a doctor about how you feel.

If you are anything like I was, you may be reluctant, or even scared, to obtain a formal diagnosis of depression, even if you suspect that you are seriously depressed.

I wanted to avoid my doctor to diagnosing depression for all sorts of reasons. I discuss this more fully in my depression blog pages, but the main fears for me were that a formal diagnosis would mean:

  • There would be a written record that I was depressed that could be disclosed (with or without my knowledge) to others in the future;
  • I may have to disclose to future employers, business partners or official agencies that I suffered from depression;
  • I may have to take medication;
  • I would never be free of the official status of ‘depression sufferer’.

Admittedly, some of my misgivings may seem a bit weird (paranoid, even?) but they arise from many years of working in a legal environment, where I have seen the use to which medical records can be put in litigation.

In any case, you may have any number of other, equally good reasons of your own for not wishing to join the ranks of the officially depressed. If that’s the case, then one option is to hope that your (undiagnosed) depression just goes away, which may in fact be possible if it is only a mild to moderate episode.

However, if you leave your condition undiagnosed and untreated, you run the risk of it getting very much worse and of it causing you more and more difficulties in crucial aspects of your life, such as your relationships or your employment.

Unfortunately, until your doctor (or, on referral, a psychologist or psychiatrist) goes through the process of actually diagnosing depression, your chances of getting the right outside help are likely to be pretty much non-existent.

So, whilst I still think that the fears I had regarding diagnosis were legitimate ones (there will, for example, be circumstances when have to disclose my depression in the future and that may affect all sorts of things such as job prospects, life insurance and so on), if I’d done nothing I think I would have faced much bigger problems, much sooner.

Diagnosing depression – how is it done?

In diagnosing whether you have depression, your doctor will need to ask you some detailed questions. The focus will be on your mood and the impact of your mood on your life over the relatively recent past.

The doctor will also need to ask you about your personal background, your family history and details of your current circumstances, such as your family situation, your work, your intake of alcohol or drugs and your physical health.

It may also be necessary for you to have blood tests to eliminate or identify any physical conditions that can contribute to mood disorders.

The idea is for the doctor to get a picture of all the factors that might be impacting on your mental state.

One method that doctors use to try to get a reasonably clear picture of your mood is to get you to complete a questionnaire. A variety of questionnaires are in use, but broadly the aim of all of them is to assess your mood by reference to the recognized criteria for assessing whether a person is suffering from depression.



diagnosing depression questionnaire

Questionnaires and checklists are often used by doctors to help them assess your state of mind when diagnosing depression


The most widely used standards (at least in the US and most English speaking countries) for assessing depression are contained in the Diagnostic and Statistical Manual of Mental Disorders (revised fourth edition – DSM-IV-TR) published by the American Psychiatric Association.

(Alternative criteria are contained in the International Statistical Classification of Diseases and Related Health Problems (ICD-10), published by the World Health Organization. ICD10 tends to be used in most European countries and, whilst there are differences between the ICD10 and DSM IV, they are similar in substance. Here we’ll focus on DSM IV.)

Based upon the DSMIV criteria for various mood disorders, the questions you doctor will ask you, or which will be contained in a questionnaire, are likely to be aimed at establishing the following:

  • If you have had a low or depressed mood;
  • If you have lost the ability to take pleasure in your usual activities;
  • If you have had changes in your weight or appetite;
  • If you are sleeping more or less than usual;
  • If you have had certain thoughts and feelings, such as guilt or worthlessness;
  • If you have had suicidal thoughts;
  • If you have had less energy than usual;
  • If you have been more lethargic or hyperactive than usual;
  • If you are physically affected, e.g. you movements have slowed down;
  • If you have had any manic episodes, including racing thoughts, hypersexual activity, reckless behavior;
  • If you have had trouble making decisions, thinking straight or concentrating;
  • If you have had any of the above symptoms, how long you have had them and how much impact they have had on your day to day functioning.

From your answers to these questions, plus the other background information you provide, you doctor will be try to diagnose whether you have depression and if so, which of the different types of depression you may have.

How easy is diagnosing depression?

It is worthwhile noting, that whilst the DSM IV criteria provide the framework around which the diagnosing of depression is carried out, there is some distinction in practice between how family doctors approach the task, compared with a more strict application of the criteria by psychiatrists.

One study of how family doctors diagnose depression, reported in the Canadian family Physician Journal, Diagnosing Depression – There is no Blood Test, found that:

  1. There was widespread use of checklists or questionnaires, although some doctors preferred to use their own questioning and listening techniques;

  2. Most doctors believed that it was necessary to try to build a rapport with the patient (over more than one appointment, if necessary) so as to be able to question the patient carefully about all the circumstances in their life that might be affected;

  3. Some doctors relied quite heavily on their gut feeling or intuition as to whether a patient might be depressed, especially if they knew the patient well.

So, it is quite obvious that the diagnosis of depression is not as straightforward as simply matching symptoms with the DSM IV criteria. Often there are many other social and physical factors involved that will complicate the picture.

It is not surprising then that one of the most significant aspects of the ‘Diagnosing Depression’ research is the emphasis that the doctors placed upon the need for sufficient time with a patient in order to be able to make a reliable diagnosis of depression.

Bearing in mind the time pressures on ordinary family practices, especially in less affluent areas, it is no wonder that studies have shown that depression can go often unrecognized by family doctors.



diagnosing depression - woman

If you are feeling depressed, consult your doctor – it may be the first step towards recovery

Conclusions

If you think that you might be depressed:

  • Go to your doctor so that if you do have depression it can be diagnosed and you can begin to get the right kind of help;

  • Make sure you get enough time with your doctor so that he or she can go through the process of diagnosing depression thoroughly – ask for a double appointment;

  • If you meet any resistance in being given enough time with your doctor and don’t have the will to do anything about it, try to get a friend or family member to speak on your behalf to put your case;

  • Before you see your doctor, give some thought to some of the questions I refer to above so that you can be sure you present as clear a picture as possible of your condition.

References

Diagnosing depression – there is no blood test Can Fam Physician 2005;51:1102-1103

Diagnostic and Statistical Manual of Mental Disorders (revised fourth edition – DSM-IV-TR) published by the American Psychiatric Association

International Statistical Classification of Diseases and Related Health Problems (ICD-10), published by the World Health Organization










Go from this Diagnosing Depression page to Depression Help (the home page)
Go from this Diagnosing Depression page to the main Depression Diagnosis category page

About the Author

Father, husband, writer and website publisher, discontented in his day-job, he writes here about depression - his own and in general. You can follow Too Depressed on Twitter. Please share the content on this site with all your friends, followers and contacts using the buttons above.

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Last revised on September 17, 2011

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