About 1 in 10 Americans suffers some form of depression, according to the National Institute of Mental Health. Women experience depression twice as often as men. Depression has devastating effects on a person’s relationships with family and friends, on the ability to do productive work, and, of course, on the ability to enjoy life.
People often say “I’m depressed” when they feel blue, down, sad, gloomy, cheerless or just plain world-weary. But for doctors and mental health professionals, depression is a condition with well-defined symptoms. Sadness is just one. Other symptoms include:
- Decreased interest and pleasure in activities that used to be enjoyable
- Persistent thoughts of death or suicide
- Loss of appetite or overeating
- Weight gain or weight loss
- Disturbed sleep patterns, either insomnia or too much sleep
- Poor concentration
- Feelings of worthlessness or guilt
When professionals use the word “depression,” they’re referring to an illness that deserves care and treatment. Some depressive disorders are mild, others severe. Depression can occur even when the person and family members can’t think of a good reason why.
Sometimes there is a trigger, such as a troubled family relationship, career disappointment, or death of a loved one. Genetics also play a role, although the specifics are poorly understood.
Depression can be associated with other medical conditions. Health-care professionals see depression more often in people who have serious health problems, such as heart disease and cancer. Depression also can occur in connection with illnesses that affect the brain, such as Parkinson’s disease and stroke.
Fortunately, depression can be treated. Drug treatment is helpful, and so is psychotherapy (talk therapy).
Are You Depressed?
Here are some questions to ask yourself:
- Do you feel unhappy, irritable or anxious?
- Have you stopped enjoying the activities that always made you happy? Or have you always had trouble enjoying yourself?
- Are you no longer able to do the things you need to do to keep things going at home or at work?
- Are you less hopeful about the future?
- Do find that it is hard to make important decisions without too much anxiety or distress?
- Do you think about hurting yourself? Do you wish for death or think about suicide?
If you can answer yes to any of these questions, especially if your answer has been yes for than a couple of weeks, you may have depression. Depression is a clinical diagnosis. This means that no laboratory test or X-ray can tell you whether you are depressed or not.
Depression is not just feeling a little down. It is diagnosed by a set of symptoms. Some symptoms indicate mild depression while other symptoms, such as considering suicide, suggest a more severe depression that requires immediate action.
Don’t find reasons or excuses not to seek professional help. With treatment, you can feel better, enjoy life more, and be more productive in the ways that matter to you.
How Is Depression Diagnosed?
Diagnosis means “to know.” The more health-care providers know about a medical problem, the greater are the odds that they can treat it. This holds true for all medical problems, including psychiatric ones.
To diagnose depression, your health-care provider will probably perform the following assessments:
- The mental-health interview and mental-status examination — Your health-care provider will ask you about your general health and recent health history, including details of your symptoms. The mental-status examination is a specific set of observations and questions geared toward determining your state of mind.
- Physical examination — Your primary-care physician should do a physical examination as part of a comprehensive evaluation.
- Diagnostic tests — Your health-care provider will occasionally order diagnostic tests (such as blood tests and X-rays) to find out if you have any medical problems causing your symptoms.
The Challenge Of Diagnosis
Making a diagnosis, especially a psychiatric diagnosis, is a challenging task.
When assessing depression, health-care providers must sort out the different types of mood disorders to make a useful and relevant diagnosis. Dysthymia (a moderate and persistent form of minor depression) is treated differently from bipolar disorder (an illness with periods of depression and periods of elevated mood called mania).
There are always gray areas, so a health-care provider’s job is to come up with a list of probable or possible diagnoses. This list provides a framework for making treatment suggestions. Refining the diagnosis is a gradual process. As you and your health-care provider learn more about your depression, keep an open mind. Don’t give up if the first approach doesn’t work. And speak up if you’re uncomfortable. For example, if you have an drug side effect you just can’t live with, tell your doctor. In many cases, your doctor will be able to suggest an alternative that will work better for you. This can be a time-consuming process, but you are likely to find a suitable treatment.
There is no specific diagnostic test for depression.
Although depression is often referred to as a “chemical imbalance,” no single chemical causes depression. Rather, there are many chemicals involved in depression, and their interactions are very complex. Even for those chemicals that are known to play a role, such as serotonin, there is no useful way to measure their concentrations.
Diagnostic tests, however, can help evaluate people who are depressed. They can help identify any medical problems that may be causing depression or any negative health effects caused by depression. Diagnostic tests are part of the overall evaluation of this disorder.
Your health-care provider will decide which tests are right for you depending on your age, your physical symptoms and your health history. If you are younger than 40 and generally very healthy, few if any tests may be ordered. If you are older than 50 and have many symptoms, your health-care provider will probably have more tests in mind.
Remember, none of these tests are tests for depression itself. They may, however, indicate what may be causing your depression. The results of these tests can help determine the right treatment for you.
In an otherwise healthy person, health-care providers will often check the functioning of the thyroid gland by measuring the levels of certain hormones in the blood. Sometimes depression is the only symptom of low levels of thyroid hormone (or hypothyroidism).
If fatigue or weight loss is part of the picture, health-care providers may obtain a complete blood count and a chemistry profile.
A complete blood count (CBC) measures the number of red and white blood cells in your blood. Low numbers of red blood cells indicate anemia. And low or high numbers of white blood cells may show that you have an infection or some problem with your immune system.
A chemistry profile evaluates the function of your kidney and liver. It also uncovers irregularities in the concentration of various substances in your body (such as sugar and cholesterol).
X-Rays And Other Imaging Techniques
Your health-care provider is not likely to order an X-ray unless he or she suspects a specific problem. For example, a chest X-ray is frequently done if there is a suspicion of some lung or heart disease. Other X-rays or scans may be part of an evaluation to rule out different kinds of cancer, although it is very uncommon for depression to be the first symptom of cancer.
Computed tomography (CT) and magnetic resonance imaging (MRI) may be used to evaluate neurological illnesses. Your health-care provider may suspect a neurological illness from the symptoms of your physical examination. An electroencephalogram may be used to diagnose a seizure disorder; it also provides other useful information about the brain’s functioning.