See Your Doctor

Your health care provider can rule out other conditions that may cause depression with a physical examination, personal interview, and lab tests. The health care provider can also conduct a complete health evaluation, discussing any family history of depression or other mental illness. They will evaluate your symptoms, including how long you’ve had them, when they started, and how they were treated. They will ask questions about the way you feel, including whether you have any symptoms of depression such as the following:

  • sadness or depressed mood most of the day or almost every day
  • loss of enjoyment in things that were once pleasurable
  • major change in weight (gain or loss of more than 5% of weight within a month) or appetite
  • insomnia or excessive sleep almost every day
  • physically restless or rundown that is noticeable by others
  • fatigue or loss of energy almost every day
  • feelings of hopelessness or worthlessness or excessive guilt almost every day
  • problems with concentration or making decisions almost every day
  • recurring thoughts of death or suicide, suicide plan, or suicide attempt

To be diagnosed with major depression, you must have at least five of the symptoms listed above with at least one of the first two nearly daily for at least two weeks.

Depression symptoms can last for months or years. They can cause significant personality changes and changes in work habits, making it difficult for others to have empathy for you. Some symptoms are so disabling that they interfere significantly with your ability to function. In very severe cases, people with depression may be unable to eat or even to get out of bed. In these cases, a person may need medication or to be hospitalized for a period of time to get them on the road to recovery.

Before your appointment, write down a list of concerns and specific symptoms you are experiencing. It is also helpful to get an in-depth family history from relatives before your appointment. Here is a list of things to consider and record before your visit:

  • your mental and physical health concerns
  • symptoms you’ve noticed
  • unusual behaviors you’ve had
  • past illnesses
  • your family history of depression
  • medications you are taking now and in the past, including both prescribed and over-the-counter medications
  • unusual side effects of medications you are taking or have taken
  • natural dietary supplements you are taking
  • your lifestyle habits (exercise, diet, smoking, alcohol consumption, drug use)
  • your sleep habits
  • causes of stress in your life (marriage, work, social)
  • questions you have about depression and depression medications

 

At your visit

In most cases, your health care provider will do a physical exam and ask for specific lab tests to make sure your depression symptoms aren’t related to a condition such as thyroid disease, anemia or cancer. If your symptoms are related to another serious illness, treating that illness may also help ease the depression.

The goal with a physical exam is usually to rule out a physical cause for depression. The physical exam will most likely focus on the nervous and hormonal systems. Your health care provider will try to identify any major health concerns that may be contributing to symptoms of clinical depression. For example, hypothyroidism, which is caused by an underactive thyroid gland, is the most common medical condition associated with depressive symptoms. Other hormone disorders associated with depression include hyperthyroidism (caused by an overactive thyroid) and Cushing’s disease (a disorder of the adrenal gland).

Additional blood tests may be ordered to check for anemia, electrolyte levels, liver function and kidney function. Because the kidneys and liver are responsible for the elimination of depression medications, impairment to either of these two organs may cause the drugs to accumulate in the body.

Other tests may include:

  • CT scan or MRI of the brain to rule out serious illnesses such as a brain tumor
  • electrocardiogram (ECG), which is used to diagnose some heart problems
  • electroencephalogram (EEG), which uses an apparatus for recording electrical activity of the brain

Corticosteroid medications such as prednisone, which people take for diseases such as rheumatoid arthritis or asthma, are also associated with depression. Other drugs, including illegal steroids and amphetamines and over-the-counter appetite suppressants, may cause depression on withdrawal. Be sure and bring a complete list of all medications, drugs and nutritional/herbal supplements you take with you to your appointment.

After discussing your mood and the way it affects your life, your provider may also ask you questions that are used specifically to screen for depression. One example of a screening test is a two-part questionnaire that has been shown to be highly reliable in identifying the likelihood of depression. When you take this test, you will be asked to answer two questions:

  • During the past month, have you been bothered by feeling down, depressed, or hopeless?
  • During the past month, have you been bothered by little interest or pleasure in doing things?

Your answer to the two questions will determine what your provider does next. They may ask you additional questions to help confirm a diagnosis of depression; if your answers indicate you do not have depression, your provider may review your symptoms again to continue the effort to find the cause. Studies show that these two questions, especially when used with another test as part of the assessment process, are highly effective tools for detecting most cases of depression. Other screening questionnaires are also available. It is very important for you to answer the questions honestly so your provider can make an accurate assessment of your condition.