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TWO. DIAGNOSIS

What are the symptoms of depression?

Anthony's comment:

It is possible that a person wouldn't recognize the symptoms he or she had in order to seek help. In fact, it isn't necessary to recognize these symptoms in order to seek help. Your doctor can help sort out and define for you what might be going on and if it is consistent with depression. Symptoms are not only emotional but physical as well, with such problems as insomnia, excessive worrying, loss of appetite, change in behaviors/activities, change in bowel patterns, etc. When I m depressed, I have found that I don't want to be bothered by people and prefer not to associate with people I once considered friends.

The signs and symptoms of depression include the following:

• Sadness or irritability

• A loss of enjoyment in once pleasurable activities

• A loss of energy

• Difficulty concentrating

Insomnia[1] or excessive sleep

• Fatigue

• Unexplained physical complaints (e.g., headache, backache, stomach upset)

• Decreased sex drive

• A change in appetite (increased or reduced)

• Feelings of hopelessness, helplessness, and/or worthlessness

• Suicidal thoughts or attempts

If these symptoms persist for more than 2 weeks, clinical depression may be present. The greater the number of symptoms present, particularly if associated with sadness or irritability, the more likely depression is present.

Suicidal thinking warrants an immediate evaluation, especially if associated with hopelessness. As can be seen from the list, many of the features of depression involve physical symptoms. Depression is not strictly a condition of the mind. Lack of energy and fatigue may make it difficult to get moving or follow through with commitments (work, school, and family). Some people exhibit psychomotor retardation[2]—a condition in which it is difficult to initiate and sustain activity. Symptoms may change over the course of a day with a worse mood in the morning and a better mood at night or vice versa.

Because of the multitude of physical symptoms in depression, many patients seen by a primary care health provider for certain physical complaints actually have depression. Certainly, a physical evaluation excluding any other medical conditions is warranted, but depression needs to be considered as a possible condition. Many times the clinician does not consider it, or when asked about mood or the possibility of depression being present, some patients may become upset, thinking their doctor considers their symptoms "all in their head." In fact, depression is a medical condition that causes real physical symptoms. Physical symptoms get better as the depression is treated.

How is depression diagnosed?

Depression is diagnosed as part of a complete psychiatric or other mental health evaluation. The evaluation includes a review of current and past symptoms, psychiatric and medical history, family history, social history, and substance-use history. In addition, there is an assessment of the current mental status[3]. Although no tests or procedures are available

Although no tests or procedures are available to diagnose depression, in certain circumstances tests may be ordered in addition to a request for a physical examination to exclude any general medical conditions as a cause for the depression.

to diagnose depression, in certain circumstances tests may be ordered in addition to a request for a physical examination to exclude any general medical conditions as a cause for the depression. Depending on the circumstances, the clinician may want to obtain collateral information from family members. Based on the symptoms, history, and mental status a specific diagnosis can be made. The DSM-IV-TR defines a major depressive episode by the following symptoms:

1. Depressed mood for most of the day, nearly every day

2. A loss of interest or pleasure in activities

3. Significant weight loss (not dieting) or weight gain or change in appetite

4. Feelings of worthlessness or inappropriate guilt

5. Decreased concentration

6. Insomnia or hypersomnia[4] (excessive sleep)

7. Psychomotor agitation[5] or retardation

8. Fatigue or loss of energy

9. Recurrent thoughts of death or suicidal ideation

All symptoms need not be present, except for at least item 1 or item 2. Additional guidelines are available for clinicians to make a diagnosis of major depression; these consider the number of symptoms present. One feature necessary for a diagnosis is either a reduction in functional capacity (academic, occupational, or social) or significant distress. There are other forms of depression in addition to major depression, such as dysthymic disorder and bipolar depression. Dysthymic[6] disorder is a chronic, "milder" depression, but it can be quite debilitating because of its chronicity. It is less associated with some of the neurovegetative[7] symptoms that characterize major depression. Bipolar depression[8] is the depressed phase of a condition called bipolar disorder, also known as "manic-depressive disorder." The features of this depression are the same as in major depression, but the patient has a history of prior manic or hypomanic[9] episodes. As part of the evaluation the clinician screens for a history of mania, because this can affect the treatment choices for bipolar depression.

  • [1] the inability to fall asleep, middle of the night awakening, or early morning awakening.
  • [2] slowed movement, usually as a result of severe clinical depression. When emotion and cognition become depressed enough, motor function can also become depressed, causing the appearance of physical slowing.
  • [3] a snapshot portrait of one's cognitive and emotional functioning at a particular point in time. It is always included as part of a psychiatric examination.
  • [4] an inability to stay awake. Oversleeping.
  • [5] hyperactive or restless movement. It can be seen in highly anxious states, manic mood states, or intoxicated states.
  • [6] the presence of chronic, mild depressive symptoms.
  • [7] that part of the nervous system devoted to vegetative or involuntary processes such as respiration, blood pressure, heart rate, temperature, sleep, appetite, and sexual arousal.
  • [8] an episode of depression that occurs in the course of bipolar disorder.
  • [9] a milder form of mania with the same symptoms but of lesser intensity.
 
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