Depression: diagnosis

A doctor diagnoses depression based on various symptoms and taking into account the patient’s life situation. He uses various diagnostic methods : an anamnestic interview is very important , a neurological examination can also be performed . When diagnosing depression, the doctor is guided by the so-called main symptoms and any other symptoms. Physical symptoms may also appear. If a diagnosis of depression is made, it can be further classified as mild, moderate or severe. Depression can occur once or repeatedly. A doctor can make a diagnosis of depression based on the characteristic symptoms and after ruling out other diseases.

What symptoms can occur with depression?

Mood swings are common in everyone’s life. But how do we recognize true depression? This is characterized by the so-called main symptoms and possible additional symptoms.

Major symptoms of depression

The main symptoms of depression include:

• depressed, depressed mood, or “feeling of inner emptiness”,
• listlessness and a feeling of bleakness,
• reduced psychomotor pace, rapid fatigue (even after minor exertion),
• decreased activity.

Other possible symptoms of depression

Other possible symptoms of depression include:

• social download ,
• reduced concentration and attention,
• reduced self-confidence,
• feelings of own worthlessness,
• feelings of guilt
• pessimistic or negative thoughts about the future,
• suicidal thoughts, self-harm, suicidal behaviour,
• Sleep Disorders ,
• decreased appetite ,
• deterioration of cognitive abilities.

In light and moderate depressive episodes, it is possible to further distinguish whether the patient has a so-called somatic syndrome in addition to the main and secondary symptoms :

• morning depression (particularly depressed mood early in the morning),
• loss of interest or pleasure in activities that usually give a person pleasure,
• waking up in the early hours of the morning (two or more hours before the usual time to get up),
• distinct loss of appetite ,
• weight loss (often more than 5% of body weight per month),
• psychomotor retardation or restlessness ,
• significant decrease in libido ( sexual desire ).

In addition, the following symptoms may occur, from which it is not possible to directly conclude that depression is present:

• weakness, physical exhaustion,
• digestive disorders ,
• headaches ,
• a feeling of pressure in the throat, a feeling of a “dumpling in the throat”,
• breathing difficulties, or with the heart or blood circulation (fainting, rapid heartbeat, etc.),
• dizziness ,
• vision problems​
• muscle tension , nerve pain ,
• memory problems.

Note: It is absolutely necessary to have the above physical symptoms clarified by a doctor! Only he can rule out that they are not organically conditioned.

Symptoms of depression are often different for women, men and children. If a patient is stuck in a depressive episode, it usually manifests itself in passivity, social withdrawal, and physical exhaustion. During a depressive episode, the patient’s tendency towards addictive behavior (e.g. alcohol addiction ) may increase. Anxiety disorders often occur at the same time as depression .

How is depression diagnosed ?

Among other things, the following criteria are decisive for establishing a diagnosis of depression:

• At least two major symptoms (three for a severe episode) are present for at least two weeks (or for a shorter period if the symptoms are severe or if they come on particularly quickly).
• To determine the severity of depression: in addition to the main symptoms, at least two other symptoms are present (for a mild episode), 3-4 other symptoms (for a moderate episode), or more than four symptoms (for a severe episode).
• The criteria for a somatic syndrome (see above) are met in the case of a mild or moderate depressive episode in which four of the symptoms described above are present.

A severe form of depression is further distinguished by whether psychotic symptoms such as delusions or hallucinations are present . For more information on the different forms of depression and their characteristics, see the article Depression: forms and course . If the physical problems that occur in a depressive disorder (e.g. headaches or nausea) are not correctly interpreted , it can make the diagnosis of depression difficult, or significantly delayed.

People with depression often also suffer from other diseases ( comorbidities ). Together with depression, some other mental illnesses can occur , such as anxiety disorders , eating disorders , somatoform disorders , personality disorders or substance abuse . Physical diseases can include pain , dementia , diabetes , malignant tumors and other chronic diseases .

Diagnostic options

The basic pillars in the diagnosis of depression are an interview with the patient and taking an anamnesis (history of previous illnesses, including illnesses in the family). In the field of mental illness, there are a number of different symptoms that a doctor will specifically ask about; it also takes into account physical, mental and social influences. During the first interview with the doctor, the patient often mentions only physical symptoms (e.g. pain), or feelings of fatigue, apathy, etc. However, these can also point to depression. In any case, a physical examination is necessary, which the doctor usually performs already at the patient’s first visit.

In order to establish the correct diagnosis, the examining doctor can further take blood from the patient and send it for laboratory examination , or he can send the patient for some of the imaging examinations ( CT or magnetic resonance of the brain , ultrasound of the blood vessels supplying the brain, etc.). The diagnosis of depression is facilitated by special questionnaires, e.g. the questionnaire according to the DSM . In addition, the cause of depression needs to be clarified.

A very simple, short but targeted “two-question test” in which the patient must answer the following two questions can also serve as a basic orientation:

• “In the past month, have you often felt down, sad, depressed, or hopeless?”
• “During the past month, have you experienced a significant loss of interest or pleasure in activities you otherwise enjoy doing?”

If the patient answers yes to both questions, it definitely deserves closer attention.

Recognizing impending suicide can save a life

People suffering from depression are at increased risk of taking their own lives. Therefore, it is important to recognize suicidal intentions in time and prevent accidents. Recognizing impending suicide can save a person’s life!

Who can I contact?

Similar to other diseases, it is very important to recognize depression early so that the necessary treatment can be started as soon as possible. In case of suspicion, therefore, do not hesitate to seek a doctor, or sensitively alert the affected person to the possible help of a specialist.

If you feel down or suspect that you are suffering from depression, you can contact a general practitioner , psychiatrist , psychotherapist or clinical psychologis