Diagnosing Depression

If you’re wondering, “Am I Depressed?” then you’re not alone. Many people with depression don’t fully know that they have it and most people with depression have not gotten treatment.

A good starting point is to take a depression test, or assessment, to find out if treatment for depression may be right for you.

 

How Depression Testing Works

There is no lab or imaging test to diagnose depression, nor does depression have measurable physical signs. Depression screening questionnaires play an important role in identifying the symptoms of depression. Brightside Chief Medical Officer Dr. Mimi Winsberg is an advocate for broad use of depression assessments. “Many cases of depression go undiagnosed for long periods of time. Screening tools can help identify those individuals who may be at risk for depression, and identify cases of depression early, while they are still easier to treat. What gets measured is easier to manage,” Winsberg says. Tests are a great starting point because they help quantify the symptoms and can help measure improvement in real time.

Taking a depression assessment may be a good first proactive step toward getting an accurate depression diagnosis. “Proper diagnosis lends itself to proper treatment selection.  We know depression is not one clinical entity but has multiple presentations or flavors. Getting properly diagnosed will help you get on the treatment plan that is right for you, and will result in the fastest improvement,” Winsberg says.

A common depression assessment is the Patient Health Questionnaire 9 (PHQ-9) which asks about the frequency with which you’ve experienced 9 core depression symptoms over the past two weeks. The PHQ-9 is considered to be the gold standard for patient self-reporting to measure major depression. You may hear the words quiz, test, screen, assessment, or questionnaire, but they are all synonymous.

Here’s what the PHQ-9 depression assessment covers:

Over the last 2 weeks, how often have you been bothered by any of the following problems?

1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling/staying asleep, sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
8. Moving or speaking so slowly that other people could have noticed. Or the opposite; being so fidgety or restless that you have been moving around a lot more than usual
9. Thoughts that you would be better off dead or of hurting yourself in some way

For each of these questions, you can answer:

• Nearly every day
• More than half of days
• Several days
• Not at all

This completed assessment generates a score, which is associated with different levels of depression. Studies have shown that these scores are reliable (but not perfect) measures of depression symptoms.

 

How does a Depression Test Support My Diagnosis and Treatment?

It’s important to understand that completing a depression assessment is just a starting point for a diagnosis – only a doctor can diagnose depression. But, completing an assessment can help you understand what you’re experiencing, motivate you to prioritize seeking care, and help prepare you to discuss your situation with a doctor.

Completing a depression diagnosis includes a further evaluation of symptoms, your history, and other context, including how much these issues are impacting your life. A doctor will want to determine whether your symptoms have persisted for longer than two weeks and understand whether this is your first experience with depression. He or she will also want to understand the impact of your symptoms on your daily life – how they may be affecting your ability to be productive at work or school, to engage socially, to get along with the people close to you, and to complete daily activities like shopping or laundry.

It’s worth noting that it’s common for depression and anxiety to occur together – it is estimated that 60% of people with depression also experience anxiety. Similar to the PHQ-9, there is also an assessment for anxiety called the Generalized Anxiety Disorder 7, or GAD-7. These questions can help determine if someone may have anxiety together with depression.

There are some scenarios when symptoms may look like depression but be caused by other things – a doctor will want to rule these out as potential causes when making a diagnosis. Some health conditions like hypothyroidism or sleep apnea can have symptoms that look like depression and some medications for other health conditions can have depressive side effects.

If your doctor determines that you have clinical depression, there are multiple treatment options available. You and your doctor should discuss what is right for you based on your circumstances and preferences.

There are three primary treatment approaches for depression:

1. Therapy, especially Cognitive Behavioral Therapy (CBT), has been shown to be effective at reducing the symptoms of depression.  Through education, introspection, and skill development, you can process emotions and modify thought and behavior patterns that are keeping you from feeling your best.
2. Medication is effective at reducing the symptoms of depression and the impact it is having on your life. It works by affecting the availability of certain neurotransmitters – the brain’s chemical messengers – and stimulating the parts of your brain associated with depression.
3. Self care includes making healthy changes to diet, sleep, exercise, stress management, and relationships to reduce depression. Small steps and habits can have a major impact.

Depression has multiple causes – biological, psychological, and social or environmental. Because of this, comprehensive treatment approaches that combine therapy, medication, and self care to address the multiple facets of depression are the most effective.

 

What should I do?

It’s important to remember that depression is very common and that you’re not alone. One in five people will experience depression at some point in their lives. The vast majority of people with depression get better with treatment.

There’s nothing to lose from taking a depression test and you may have everything to gain. Knowing where you stand empowers you to figure out what you can do about it.