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Diagnosing Depression

Major Depressive Disorder and other Depressive Disorders (Dysthymia, Diagnosing Depression

Major Depressive Disorder and other Depressive Disorders (Dysthymia, Seasonal Affective Disorder, Minor Depressive Disorder, Postpartum Depression, Premenstrual Dysphoric Disorder) are diagnosed based on a clinical assessment performed by a physician, psychologist or other mental health worker.  This assessment usually includes an interview with the patient and a review of any previous assessments in the medical records, and can also include an interview with the patient's family members or close friends.  The goal of this assessment is to determine whether the patient meets the clinical criteria for a Depressive Disorder based on the information that they or their family members provide. 

There are no laboratory tests or imaging tests (such as CT scans or MRI scans) that can help make a diagnosis of Major Depressive Disorder or other Depressive Disorders.  However, these sorts of tests are often important in order to rule-out any other general medical conditions that may be contributing to or mimicking the symptoms of a Depressive Disorder (see here for a list of such conditions). 

Differential Diagnosis of Depressive Disorders

When making a diagnosis of a Depressive Disorder, it is very important to rule-out the possibility that the person may in fact have an underlying Bipolar Disorder. This is because Depressive Episodes and symptoms can also occur in the context of Bipolar Disorder. Yet treatments for Bipolar Disorder are very different from those used for Depressive Disorders. If a person with Bipolar Disorder is given medications for Depression then their condition can get seriously worse. There are certain clinical clues that should raise one's suspicion that a person's Depression may in fact be due to Bipolar Disorder (see here for more information).

There are other psychiatric conditions that can also be difficult at times to differentiate from Major Depression or other Depressive Disorders:

In elderly individuals who develop a Depressive Disorder, especially if for the first time in their lives, it is important to check whether they may be starting a dementia. In many cases, depressive symptoms can be among the first symptoms of a developing dementia.

Substance abuse and dependence can also lead to depressive symptoms. In particular, long-term and heavy alcohol or sedative use, as well as coming off from these substances or from drugs like cocaine and amphetamines, can lead to Depression. In these cases, it is preferable to wait and see how an individual does after 4 weeks of being (more or less) free from using these sorts of substances before making a diagnosis of a Depressive Disorder.

See here for a list of general medical conditions that can lead to depressive symptoms.  

Diagnostic Tools for Depressive Disorders

Sometimes, clinicians may use questionnaires to help identify patients with Depressive Disorders and to document the severity of their patient's symptoms.  These include:

The Beck Depression Inventory, second edition (BDI-2): This is a questionnaire that is completed by the patient, who rates the extent to which he or she has been experiencing various symptoms of Major Depression.  Based on the responses, it is possible to have an idea about the severity of the Major Depressive Episode

The Hamilton Rating Scale for Depression (HAM-D, HRSD): This questionnaire is completed by a mental health professional following a clinical interview with a patient.  It is designed to evaluate the presence and severity of the various symptoms of Major Depression, and to provide an overall score that gives an idea of the severity of the Major Depressive Episode.

The Montgomery-Asberg Depression Rating Scale (MADRS):  This questionnaire is completed by a mental health professional following a clinical interview with a patient.  It is designed to evaluate the presence and severity of the various symptoms of Major Depression, and to provide an overall score that gives an idea of the severity of the Major Depressive Episode.  It is similar to the HAM-D, except that it focuses less on the physical symptoms of a Major Depressive Episode, such as fatigue, appetite or sleep, and more on the cognitive or psychological symptoms, such as sadness, tension, pessimistic thoughts and suicidal thoughts.  The MADRS may thus be more useful for patients with known medical conditions, or elderly patients, where they may be more likely to have various physical symptoms that are not due to a Major Depressive Episode.

The Cornell Dysthymia Rating Scale (CDRS):  This is a questionnaire that is completed by a mental health professional following a clinical interview with a patient.  It is designed to evaluate milder but more chronic symptoms of Depression that are found in Dysthymic Disorder.

The Postpartum Depression Checklist and the Edinburgh Postnatal Depression Scale:  These are two questionnaires that are completed by mothers to help detect whether they may be suffering from a Postpartum Depression.  These questionnaires are useful as screening tools to detect this important problem that might otherwise not have come to clinical attention.  The Postpartum Depression Scale also has a section that screens for Postpartum Psychosis.

The Daily Record of Severity of Problems (DRSP):  This is a questionnaire that is completed by the patient to document the presence of severity of symptoms of Premenstrual Dysphoric Disorder.  Symptoms are rated daily over a selected period of days in order to determine whether they correspond with the woman's menstrual cycle.

 

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