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Depression: Diagnosis and Symptoms

by Helen Farrell, MD
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    00:01 Let’s talk a little bit now about the symptoms of depression and how you actually go about diagnosing it.

    00:06 Very important again because as we just learned, many people will be diagnosed with depression.

    00:12 So let’s consider the following example.

    00:15 When you’re talking about the diagnosis of depression, patient must meet at least five of these criteria, five or more.

    00:24 And of note, one of the criteria must be trouble with sleep or interest.

    00:29 So, the criteria include a depressed mood, almost everyday for about two weeks.

    00:36 Also, anhedonia, that’s decreased interest or pleasure in activities that someone once found enjoyable.

    00:42 So you might encounter a patient who used to play basketball or soccer and all of a sudden, they’re not interested anymore.

    00:49 That would be an example of anhedonia.

    00:52 Someone might experience appetite or weight changes, this can be either eating too much or too little.

    01:00 Also, sleep disturbance, which can be hypersomnolence, sleeping for hours, over seven, eight, ten, twelve, fourteen hours in a day or even more.

    01:11 Or decreased sleep where somebody’s barely getting any rest.

    01:16 Another key factor is to ask people what time of day they wake up.

    01:20 Often, very early awakenings, so waking up early in the morning before the sun comes up, can be a sign associated with depression.

    01:29 Psychomotor agitation or retardation are other symptoms of depression.

    01:35 So this would look like a patient who’s very anxious and fidgety, moving around a lot or having retarded psychomotor function where they barely move, maybe they describe to you that they just can’t get out of bed, that their feels like lead, and they just can’t move, even though they’re wide awake.

    01:52 Loss of energy is another symptom as is feeling worthless or excessively guilty about something out of their control, also trouble concentrating.

    02:04 So patient might describe to you that all of a sudden, their work colleagues were telling them that their work isn’t quite as good anymore or they’re not keeping up with tasks like they once did.

    02:14 That can be a subtle sign of depression.

    02:17 And finally, recurrent thoughts of suicide can be another sign of major depression because suicide is such an important component of psychiatry, I want to emphasize again here the importance of asking patients about suicide and self-harm and then always going one step further to ask them if they have any plan to harm themselves or any intention to do so.

    02:43 When you’re assessing someone for depression, it’s very critical that you also ask them about how their symptoms are influencing their social and occupational functioning because it’s not enough to meet five or more of the depressed symptom criteria, but the symptoms also have to cause a marked impairment in this person’s ability to function in day to day life.

    03:05 Also, it’s vital that you rule out that their symptoms could be due to a medical illness or a substance use problem.

    03:13 There are several types of major depressive disorders.

    03:17 Let’s consider a few.

    03:19 There’s anxious distress, atypical features, catatonia, psychotic symptoms, dysthymia, seasonal patterns, melancholia, mixed episodes, and also peripartum depression.

    03:39 We’ll go through these in a little bit more detail later.

    03:44 I want to summarize first those nine target symptoms of depression that we talked about earlier and remember a patient has to meet five or more of these with one of two symptoms being either loss of interest or sleep disorder in order to qualify for the depression diagnosis.

    04:01 A really handy way to remember the target symptoms is this pneumonic, SIGECAPS.

    04:07 So let’s go through that.

    04:09 This is really going to help you remember the depressed symptoms.

    04:12 So the S stands for sleep.

    04:14 The I is for interest being low such as anhedonia.

    04:18 There’s guilt, energy changes, concentration difficulties, appetite changes, psychomotor activity or retardation and suicidal thinking.

    04:30 And these again are the symptoms, the target symptoms, that you’re screening for in patient whom you suspect might have depression.

    04:39 Just like with every psychiatric disorder, it is critical that you rule out general medical conditions before diagnosing a psychiatric disorder.

    04:49 There are lot of medical conditions or problems that can mimic depression.

    04:54 These can be easily treated and reversed.

    04:57 So check out this list of the major medical causes of depression.

    05:01 It includes cerebrovascular disease, endocrine problems, neurology problems, various viruses, cancer, collagen vascular diseases, and also chronic pain.

    05:14 There are also substances that can cause depression.

    05:17 So here’s a list of a few of the common causes of depression brought on by actually a substance whether it’s an illicit use or actually a medication.

    05:29 So some of the ones to highlight are things like alcohol, this can very much bring on something that looks likes depression, but so can prescribed drugs, things like diuretics and beta blockers.

    05:41 So keep this in mind when you’re assessing a patient.

    05:47 There can also be depressive symptoms due to specific medications and this is a more exhaustive list here.

    05:54 So for any patient whom you’re considering a diagnosis for depression, it’s very important to do a couple of things.

    06:00 One is to do a thorough medical history as well as a physical exam.

    06:06 You really need to screen them for what kind of medical conditions they have or symptoms of a medical condition because that might be very treatable.

    06:14 It’s also important to obtain an exhaustive medication lost from your patient including a list over-the-counter medications that they’re taking because often these can mimic symptoms of depression just as alcohol and illicit substances can also bring about the target symptoms for depression.

    06:34 It’s important as well to do a screening by doing some baseline blood work or lab work on your patient, checking things like a complete blood count, ruling out viruses, checking their renal or kidney function and also their liver function.

    06:51 You always want to check a thyroid hormone as well as other vitamins such as B12 and folate.

    06:58 You always want to do a urine tox screen as well to make there aren’t any drugs that could be in their system accounting for their symptoms.


    About the Lecture

    The lecture Depression: Diagnosis and Symptoms by Helen Farrell, MD is from the course Major Psychiatric Disorders. It contains the following chapters:

    • Cause of Depression
    • Types of Depression
    • Rule Out General Medical Conditions

    Included Quiz Questions

    1. Alternating mood with depression and anxiety every day.
    2. Psychomotor agitation or retardation.
    3. Recurrent thoughts of suicide.
    4. Loss of interest in once pleasurable activities.
    5. Changes in appetite and weight.
    1. Obtain EEG of brain for every patient as a part of routine check-ups.
    2. Take detailed info regarding current medications in detail including over the counter drugs.
    3. Take a thorough medical history and do a complete physical exam.
    4. Check complete blood counts, renal, liver functions tests and urine drug screen.
    5. Check levels of vitamins and thyroid hormones.
    1. Somatic
    2. Atypical
    3. Mixed
    4. Seasonal
    5. Dysthymia

    Author of lecture Depression: Diagnosis and Symptoms

     Helen Farrell, MD

    Helen Farrell, MD


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