Let’s talk a little bit now about
the symptoms of depression
and how you actually go
about diagnosing it.
Very important again because
as we just learned,
many people will be
diagnosed with depression.
So let’s consider the following example.
When you’re talking about the
diagnosis of depression,
patient must meet at least five
of these criteria, five or more.
And of note, one of the criteria must
be trouble with sleep or interest.
So, the criteria include a depressed mood,
almost everyday for about two weeks.
Also, anhedonia, that’s decreased
interest or pleasure in activities
that someone once
So you might encounter a patient who
used to play basketball or soccer
and all of a sudden, they’re
not interested anymore.
That would be an
example of anhedonia.
Someone might experience
appetite or weight changes,
this can be either eating
too much or too little.
Also, sleep disturbance, which can be
hypersomnolence, sleeping for hours,
over seven, eight, ten, twelve,
fourteen hours in a day or even more.
Or decreased sleep where somebody’s
barely getting any rest.
Another key factor is to ask people
what time of day they wake up.
Often, very early awakenings,
so waking up early in the morning
before the sun comes up,
can be a sign associated with depression.
Psychomotor agitation or retardation
are other symptoms of depression.
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.
Loss of energy is
as is feeling worthless or excessively
guilty about something out of their control,
also trouble concentrating.
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.
That can be a subtle
sign of depression.
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.
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.
Also, it’s vital that you
rule out that their symptoms
could be due to a medical illness
or a substance use problem.
There are several types of
major depressive disorders.
Let’s consider a few.
There’s anxious distress,
and also peripartum depression.
We’ll go through these in a
little bit more detail later.
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.
A really handy way to remember the target
symptoms is this pneumonic, SIGECAPS.
So let’s go through that.
This is really going to help you
remember the depressed symptoms.
So the S stands for sleep.
The I is for interest being
low such as anhedonia.
There’s guilt, energy changes,
appetite changes, psychomotor activity
or retardation and suicidal thinking.
And these again are the
symptoms, the target symptoms,
that you’re screening for in patient
whom you suspect might have depression.
Just like with every
it is critical that you rule
out general medical conditions
before diagnosing a
There are lot of medical conditions or
problems that can mimic depression.
These can be easily treated and reversed.
So check out this list of the major
medical causes of depression.
It includes cerebrovascular disease,
endocrine problems, neurology problems,
various viruses, cancer, collagen
vascular diseases, and also chronic pain.
There are also substances
that can cause depression.
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.
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.
So keep this in mind when
you’re assessing a patient.
There can also be depressive
symptoms due to specific medications
and this is a more
exhaustive list here.
So for any patient whom you’re
considering a diagnosis for depression,
it’s very important to
do a couple of things.
One is to do a thorough medical
history as well as a physical exam.
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.
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.
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.
You always want to check a
thyroid hormone as well as
other vitamins such
as B12 and folate.
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.