Depression Diagnosis

Perform Thorough Diagnostic Evaluation

• Determine if other psychiatric or general medical conditions are present
• Should include but is not limited to:
  • Physical exam
  • Mental status exam
  • History of past and current illnesses
  • History of suicidal thoughts and suicide attempts
  • General medical history
  • Psychiatric history
    • To include symptoms of mania because presence of manic symptoms would prompt that the patient be diagnosed with bipolar disorder
  • Family history of psychiatric disorders
  • Substance abuse history
  • Medication review
  • Mental status evaluation
  • Diagnostic tests as indicated
    • Screening tools eg Patient Health Questionnaire (PHQ9), PHQ2 or Two-Question Screen, Beck Depression Inventory for Primary care
  • Evaluation of functional impairment
  • Evaluation of life events and stressors

Diagnostic Criteria

• Based on DSM-5 diagnostic criteria, major depressive disorder is diagnosed when 5 or more of the following symptoms that causes change or distress in previous functioning have been present during the same 2 week (and at least one of the symptoms is either depressed mood or lack of interest or pleasure):
  • Depressed mood in adults or irritable mood in children that either self-reported or observable most of the day, nearly every day
  • Lack or diminished interest or pleasure in almost all activities most of the time, nearly every day
  • Significant weight loss when not dieting, weight gain or appetite disturbance in adults. While in children, this can be failure to attain expected weight gain
  • Sleep disturbance that can be insomnia or hypersomnia nearly every day
  • Psychomotor agitation or retardation
  • Feeling of fatigue or lack of energy nearly every day
  • Sense of diminished/lost of self-worth or inappropriate guilt nearly every day
  • Inability to concentrate and there is indecisiveness
  • Frequent thoughts of death, could be of suicidal attempts, with or without specific plan
• The symptoms should not be a physiological effect of any substance as well as any general medical condition
• The disorder occurrence is not due to schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders
• Manic and hypomanic episodes have not occurred
• Distinguishing between normal sadness and grief from major depressive disorder is important
  • Bereavement induces great suffering but does not typically induces major depressive disorder
  • When bereavement and major depressive disorder concurrently exist, the latter has more severe symptoms and functional impairment and worse prognosis compared to bereavement alone
  • Diagnosis of major depressive disorder in a patient who had significant loss would need clinical judgment based on the patient’s history and cultural context for expression of grief