How is Depression Diagnosed?

1. Causes & Symptoms of Depression
2. How is Depression Diagnosed?
3. How is Depression Treated?

Medically-reviewed articles:

• Types of Depression
• Co-Occurring Mental Illness and Substance Abuse

Understanding Depression Part 2 

This lesson will be about the diagnosis if someone has depression.

Depression is usually diagnosed by psychiatrists. In addition, addiction medicine specialists, primary care physicians and clinical psychologists are diagnosing this disorder. In order to be diagnosed with a depressive disorder, a diagnostic criteria from the DSM-5 must be met.   The DSM-5 is a diagnostic and statistical manual of mental disorders by the American Psychiatric Association.

Many medical conditions and substance use disorders can mimic signs of depression. And it is important to take this in consideration when making a diagnosis.

The DSM-5 defines different types of depression.

Major depressive disorder, substance medication induced depressive disorder, disruptive mood dysregulation disorder, persistent depressive disorder, premenstrual dysphoric disorder, depressive disorders due to another medical condition. And other unspecified depressive disorder. We will be focusing on major depressive disorder and substance induced depressive disorder as these commonly occur.

It is important to note that depression can also be a symptom seen with many other mental health diagnoses, such as in bipolar disorders, schizoaffective disorder, PTSD, which is post-traumatic stress disorder, psychotic disorders such as schizophrenia and in anxiety disorders. Actually, 71% of people with depression have symptoms of anxiety.

In order to be diagnosed with major depressive disorder, an individual must meet DSM-5 criteria. The DSM-5 criteria for Major Depression include:

* The individual must have five or more symptoms during a two-week period with a change in previous functioning plus at least depressed mood or loss of interest or pleasure. 

Symptoms include:

• Depressed mood, and the depressed mood must be every day or nearly every day.  And this can be indicated by either subjective report, such as the patient reported feeling sad or empty or by observations made by others.
• Diminished interest or pleasure in almost all activities, most of the day, nearly every day. And this can be indicated by either subjective account or observation.
• Significant weight loss while not dieting. Or increase in appetite nearly every day.
• Insomnia or hypersomnia, nearly every day.
• Psychomotor agitation or retardation, nearly every day.  This needs to be observed by others, not just by subjective feelings of restlessness or being slowed down.
• Fatigue or loss of energy, nearly every day
• Feelings of worthlessness or excessive or inappropriate guilt.
• Diminished ability to think or concentrate or indecisiveness.  This can be by subjective account or as observed by others.
• And finally, recurrent thoughts of death, not just fear of dying, recurrent suicidal ideations without specific planned or a suicide attempt. Or a specific plan for committing suicide.

In addition to having five of the symptoms mentioned above,

• These symptoms must cause clinically significant impairment in social, occupational, or other important areas of functioning.
•  The depressive episode isn’t due to the physical effects of a substance or to another medical condition.
•  The occurrence of episode is not better explained by schizoaffective disorder or a psychotic disorder.
•  And finally, there has never been a manic or hypomanic episode. If there is, the individual may have bipolar disorder or bipolar depression and the treatments are different than for Major Depression.

In order to diagnose substance induced depressive disorder.

You would need the following criteria:

• A prominent and persistent disturbance in mood. Characterized by depressed or markedly diminished interest or pleasure in all or almost all activities.
• There is evidence from a physical exam, laboratory findings or both of symptoms developed during or soon after substance intoxication or withdrawals or after exposure to a medication AND the involved substance or medication is capable of producing these symptoms.
• The disturbance is not explained by depressive disorder that is not substance induced AND the symptoms preceded onset of a substance use, symptoms persist for substantial amount of time after the cessation of acute withdrawals or intoxication, or there is a history of recurrent non substance induced depression.
• The disturbance does not occur exclusively during the course of a delirium.
• And finally, the disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

In the next lesson we will discuss how to treat depression.

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