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Diagnosing Depressive Disorders
 

DIAGNOSTIC TIPS FOR IDENTIFYING DEPRESSION

Probably the most important tool physicians have to help them detect depression is time. Many patients, especially elderly patients, are uncomfortable discussing their feelings and will limit their complaints to vague physical problems in an attempt to "legitimize" their visit to the doctor's office. Allowed and indeed encouraged to talk, most patients will expand on their mood and discuss feelings of anxiety and depression more freely. The key is to avoid interrupting the patient too frequently or too soon, even though the patient may seem to be rambling. Eventually, their stories may reveal an underlying mood disorder.

While time is always a constraint in a busy practice, keep in mind that even the most talkative patient is not going to spend more than a few minutes discussing his or her feelings. By interrupting them too soon in the history taking, patients may be discouraged from telling their story and the mood disorder may never surface. If physicians suspect a patient is depressed, they may wish to ask the following questions: "If something good happens, how do you feel about it? Does it feel as good as you think it should, or does the feeling last as long as it should?"

Unhappy patients still feel happy when something good happens, depressed patients stay depressed. Keep in mind, too, that while any loss can trigger a major depressive illness, grief is a normal response to loss, depression is not.

Points to keep in mind when trying to elicit the diagnosis of depression

1. How severe is the patient's reaction to the loss or stressor?
2. How long has the patient been reacting this way?
3. To what degree have symptoms interfered with their ability to function?
4. Is their self-esteem still intact despite the depressed mood?
5. Is the patient normally optimistic or did they always have difficulty coping with change?
6. Are there any medical conditions (anemia, hypothyroidism) that could explain depressive symptoms? As does depression, medical illness may similarly affect sleep, appetite and energy. However, ill patients who are also depressed are prone to feelings of excessive guilt and hopelessness. In the presence of other medical conditions, cognitive changes are important clues to depression and should be elicited on history.
7. Could a friend or partner provide important insights? Many depressed patients either do not recognize or tend to minimize symptoms of depression. An interview with a friend or the patient's partner can be most helpful when trying to establish mood changes in the affected individual.

 

Please see:

Section I: "Making the Diagnosis"
CANMAT – Guidelines for the Diagnosis and Pharmacological Treatment of Depression
(1st Edition Rev., 1999)
Figure 1 – P. 9

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Over one million Canadians suffer from some form of depressive illness.