Depression Diagnosis

Depression consists of several types of disorders, the most common of which are major depressive disorder, dysthymic disorder, and bipolar disorder. There are also other, less common types of depression.

Major Depressive Disorder

This is also called major depression, and is diagnosed when a patient experiences at least five symptoms of depression for 2 weeks or more and these symptoms make it difficult for them to function normally at work, school, or in their daily activities. The symptoms are sadness most of the day, loss of pleasure or interest in activites, significant weight change, insomnia or excessive sleep, agitated movement or very slow movements, fatigue or loss of energy, feeling worthless or guilty, indecisiveness and loss of concentration, thoughts of death or suicide.

Dysthymic Disorder

Dysthymia, as it is also called, is characterized by chronic depressive symptoms lasting for two years or longer but is less severe than that of major depression. Its symptoms are not severe enough to be disabling, however it can prevent the individual from feeling well or functioning normally. THe most common symptoms are loss of pleasure or interest in activities, low self-esteem and low energy.

Bipolar Disorder

This is also known as manic depression. It is characterized by cycles of mood involving extreme joyfulness (mania) or extreme sadness (depression). During a manic episode, there are inappropriate and severe feelings of elation or irritability, grandiose notions, disconnected or racing thoughts, fast speech, increased energy levels, and inappropriate social behavior. Persons with Bipolar II disorder have periods of depression alternating with periods of “hypomania”, a milder form of mania with high energy, decreased sleep and some agitation.
See section on bipolar disorder >>

Other Types of Depression

Adjustment Disorder with Depressed Mood

This occurs following a major life changing event, such as a loss of job, loss of a loved one, breakup of a relationship. This usually lasts a few weeks to a few months.

Minor Depression

Its symptoms are similar to major depression and dysthemia, but are less severe or are of a shorter duration.

Mood Disorder Due to a General Medical Condition

Several medical conditions such as hormonal problems, stroke, and Parkinson’s disease cause changes in the body that could make predispose that particular patient to depression.

Premenstrual Dysphoric Disorder

This is experienced by a lot of women a week before menstruation. This disappears once the cycle is over.

Postpartum Depression

New mothers are vulnerable to experience depression after giving birth. In some cases, there may even be symptoms of psychosis like hallucinations (hearing or seeing things) and delusions (false beliefs).

Psychotic Depression

This is characterized by a severe depressive illness that is accompanied by symptoms of psychosis where a person sees or hears things that are not real.

Seasonal Affective Disorder

This typically occurs during autumn or winter when there is less natural sunlight, and resolves during spring and summer. This can be treated with light therapy, but sometimes antidepressant medication and psychotherapy are combined with light therapy.

Symptoms of Depression

Symptoms of depression can include the following:

• Appetite change, usually accompanied by weight loss or weight gain.
• Lack of interest in previously loved and enjoyed activities.
• A sudden lack of activities, in general.
• Trouble concentrating.
• Feelings of hopelessness or helplessness.
• Feelings of guilt, worthlessness, and self-hate.
• Prolonged irritability and bad moods.
• Recurring thoughts of suicide or death.
• Moving slower or faster than usual.
• Sudden lack of energy or fatigue.
• Problems sleeping, either too much or too little sleep.
• Persistent physical symptoms that do not respond to treatment (eg, headaches, chronic pain, digestive disorders).

Differences in Men and Women

Men are less likely to admit feelings of hopelessness and self-loathing than are women. Instead, they tend to experience low energy, irritability, aggression, violence, reckless behavior, and anger. They are more likely to complain of fatigue, sleep problems, and loss of interest in work and hobbies.

Compared to men, onset of depression in women tends to be at an earlier age and episodes tend to be longer and to recur. Women are more likely to experience feelings of guilt and anxiety, overeating, gain weight, and excessive sleep. Women are also more likely to have a seasonal pattern to depression.

Depression in Teens and Children

Approximately 1 in 8 teens and 1 in 33 children are diagnosed as having clinical depression.

Depressed teens more often than not exhibit irritability rather than depression. They also tend to easily lose interest in activities and hobbies that they had previously enjoyed and to take more risks and be less concerned with their safety. Teens exhibiting symptoms of depression are more likely to experience major depression during their adult years.

Children, on the other hand, tend to show sadness, develop physical complaints such as headaches or stomach aches, poor grades in school, and changes in eating and sleeping patterns.

Once there is a suspicion of a depressive disorder, the first step would be to visit a doctor. Assessment through a careful and thorough health history is taken, and information like the onset of symptoms, how long they have lasted, how severe they have been, previous occurrence of the symptoms, the daily stressors and the support systems that the affected individual have in place are relevant. A family history of depression or any mental illness and alcohol and illicit drug use and abuse are also asked. An individual’s risk for harming oneself and suicide are also assessed.

A physical examination is performed to evaluate the overall health and to exclude other medical conditions and medications that may cause the same symptoms as depression. A mental status examination may be conducted, which would evaluate the patient’s thought patterns, speech, and memory. Mildly depressed people usually appear normal, but severely depressed individuals tend to neglect their appearance (eg, poor hygiene, change in weight). They may also exhibit slow speech, monotonous voice, and less spontaneous movements and reactions.

Diagnostic tests such as blood tests (eg, complete blood count, blood chemistry, thyroid function tests, vitamin B12 levels), electroencephalogram (EEG), and imaging tests (eg, computed tomography, magnetic resonance imaging, PET scans) could not diagnosed mental disorders, however, these tests can diagnose other neurological disorders like brain tumors and stroke.