Test Your Knowledge

Before major depression can be diagnosed, a physician should perform a physical examination to rule out other conditions that may be causing symptoms. Many people who are eventually diagnosed with major depression visit their primary care physician first because they suspect there is a physical problem. However, a mental health professional can also diagnose major depression.

Diagnosis of major depression typically begins with a medical history, including information about the onset, duration and severity of symptoms. The physician or mental health professional will also ask whether the patient has experienced these symptoms before and, if so, whether and how they were treated and whether treatment was effective. Patients will also be asked about alcohol and drug use, whether they have thought about death or suicide and whether other family members have had depression or other mental illnesses. If there is a family history of depression, the practitioner will ask how it was treated.

A diagnostic evaluation may also be performed. This examination of the patient’s mental status determines if memory, speech or thought patterns have been affected. A blood analysis should also be performed to rule out some medical conditions (e.g., anemia, thyroid disease, low levels of vitamin B12 or vitamin D) that can cause symptoms similar to those of depression.

Despite being a serious and common disorder, major depression is frequently underdiagnosed for many reasons. Some people believe there is a stigma attached to seeking help for any potential mental health condition. Major depression may be overlooked in pregnancy and many medical conditions with similar symptoms. Diagnosis in adolescents may be difficult because many adults may expect moodiness in teens. Men may be more reluctant to seek treatment or talk about emotional problems.

Many family physicians believe their patients will not accept a diagnosis of a "mental problem," and as a result do not document the diagnosis. Others are uncomfortable with talking with people about some of the problems associated with major depression and therefore avoid or change the subject when someone brings up depressive symptoms. This is decreasing with increased emphasis on training family doctors in this area, but may still occur. If it happens to you, do not fail to ask your doctor or nurse for a referral to a psychiatrist to get a specialist’s opinion about your symptoms.

The American Psychiatric Association (APA) lists strict criteria for the diagnosis of major depression. These criteria must be present for at least two weeks. The symptoms include at least five of the following:

• Altered mood
• Loss of interest in usual activities (anhedonia)
• Substantial change in appetite or weight
• Too little or too much sleep
• Observable agitation or sluggishness in activity
• Fatigue
• Reduced feelings of self-worth
• Problems with concentration
• Thoughts about death or suicide

Symptoms that can be explained by a general medical condition, or those due to other diagnosed mental disorders, are not considered in the diagnosis of major depression. For instance, fatigue or weight change due to a medical problem or procedure would not be considered symptoms of major depression.

The symptoms of major depression are present for most of the day, nearly every day, for at least two weeks. In addition, major depression is diagnosed when the symptoms are severe enough to interfere with normal life.