Analyzes and examination for depression, test. Depression General information about the disease

During the first visit to diagnose depression, the doctor asks the patient questions about their mood and thoughts. They may also ask you to complete some simple tests to check for symptoms of depression.

If, after the initial interview, the doctor suspects the presence of depression, he conducts a full range of laboratory tests and psychological tests. This allows you to exclude other diseases with similar symptoms, confirm the diagnosis of depression and identify complications caused by the disease.

Typically, diagnosis includes the following activities.

Physical condition check

Measurement of height and weight, measurement of blood pressure and temperature, listening to the heart and lungs, palpation of the abdominal cavity.

Laboratory tests

Complete blood count, blood test for alcohol and drugs, blood test for thyroid hormones.

Psychological research

Concludes in a conversation with a psychotherapist. The doctor asks the patient about his thoughts, feelings, behavior, learns about the symptoms of the disease: when they appeared, how acute they are, how they affect daily life, whether you have experienced episodes of depression in the past. If the patient is visited by thoughts of suicide, the doctor discusses this issue in detail with the patient.

Diagnostic criteria for depression

The symptoms of major depression are similar to those of several other illnesses, so making a diagnosis requires a thorough diagnosis. To distinguish major depression from other diseases, the doctor conducts a detailed examination of the patient. When making a diagnosis, the doctor must exclude the following diseases that have symptoms similar to depression.

Adjustment disorder

Adjustment disorder is observed during the period of adaptation to a significant change in social status (loss of loved ones or prolonged separation from them, the position of a refugee) or to a stressful life event (including a serious physical illness). This mental state affects the thoughts, feelings and behavior of the patient.

Bipolar disorder

This type of depression is characterized by mood swings from euphoria to depression. Bipolar disorder is often confused with major depression, although it is the correct diagnosis in this case that determines the outcome of treatment.

Cyclothymia

Cyclothymia is called mood swings, not reaching the manic-depressive psychosis (bipolar disorder).

postpartum depression

This type of depression occurs in new mothers, usually one month after the birth of a child.

Psychotic depression

This is a severe depression, accompanied by psychosis, which is expressed by delusions and hallucinations.

schizoaffective disorder

Schizoaffective disorder is an illness that manifests itself as both schizophrenia and mood disorders.

seasonal depression

This type of depression is associated with the change of seasons and lack of sunlight.

Major depressive disorder differs from these disorders in terms of symptoms and severity. For a correct diagnosis, the symptoms must meet the following diagnostic criteria:

symptoms are present daily for two or more weeks;
depressed mood;
loss of interest in daily activities;
significant unplanned weight gain or loss;
sleep problems: too long or too short sleep, falling asleep for a long time;
feeling of anxiety, anxiety;
lethargy, slowness;
fatigue, lack of energy;
a drop in self-esteem, the appearance of guilt;
problems with concentration, decision-making;
thoughts of death and/or suicide;
the symptoms cause mental anguish in the patient and affect daily life.

If you are going to see a doctor about depression, we will provide you with a list of tests and tests that the doctor will order you to have. But keep in mind that not all tests are designed to detect depression. Most of these are done not to define depression, but to rule out the possibility of a more serious physical illness that can cause depression-like symptoms.

First of all, the doctor will conduct a general examination and prescribe tests that will determine whether your condition is caused by diseases such as low thyroid function or cancer. If the symptoms of depression are caused by a serious physical illness, then treatment of this disease reduces the manifestation of symptoms of depression.

What does the doctor pay attention to during a general examination during the diagnosis of depression?

During a general examination, the doctor will pay special attention to the nervous and hormonal systems. He will try to identify all physical ailments related to depression. For example, hypothyroidism - an underactive thyroid gland - is the most common physical ailment associated with symptoms of depression. Other types of hormonal disorders are hyperthyroidism - hyperfunction of the thyroid gland - and Cushing's syndrome - a disorder of the adrenal gland.

A variety of diseases or injuries of the central nervous system can also cause symptoms of depression. For example, depression is associated with any of the following conditions:

Tumor of the central nervous system

Head injury

Multiple sclerosis

Different types of cancer (such as pancreas, prostate, or breast)

Medications based on corticosteroid hormones, such as prednisone, taken for diseases such as rheumatic fever or asthma, are also associated with depression. But drugs based on illegal steroid hormones or amphetamines, as well as appetite suppressants, in turn cause depression when they are stopped.

What laboratory tests will the doctor perform in the process of diagnosing depression?

After doing a general examination of the body and analyzing the information you provide, the doctor will be able to tell if you are sick with depression or not. But, in order to exclude the presence of a serious physical disease, the doctor may prescribe additional tests. Most likely, he will order a blood test to check if you have an illness that provokes the manifestation of symptoms of depression. Based on the results of this analysis, the doctor will be able to determine if you have anemia, check the function of the thyroid gland and the level of calcium in the body.

Are there additional laboratory tests that a doctor may order before making a diagnosis?

Yes, the doctor may prescribe other standard tests during the examination of the general condition of the body. For example, a blood test to determine the level of electrolytes, the condition of the liver and kidneys. Because the liver and kidneys are responsible for removing drugs from the body, dysfunction can lead to a buildup of medications taken and, as a result, depression.

Additional laboratory tests include:

Computed tomography or magnetic resonance imaging of the brain to rule out the possibility of a serious condition such as a brain tumor

An electrocardiogram (ECG) designed to detect an arrhythmia or heart block

Electroencephalogram (EEG), designed to determine the level of electrical activity of the brain

Are there special tests for diagnosing depression?

After asking about your mood and how it affects your daily life, your doctor will ask you specific questions that are asked when diagnosing depression. At the same time, it must be remembered that all the questionnaires and questionnaires that the doctor uses when making a diagnosis are just tools for analyzing your condition. The information obtained from these questionnaires will give your doctor a deeper understanding of your mood. He necessarily uses these results when making an accurate diagnosis.

One example of such tests is a questionnaire consisting of two questions:

1. Have you been bothered by feelings of being overwhelmed, depressed, or helpless during the past month?

2. Over the past month, have you experienced a feeling of indifference to activities you once loved?

How you answer the questions will determine the doctor's next steps. He may ask you additional questions to confirm the diagnosis. Or, if the answers indicate that you don't have depression, your doctor will do more tests and tests to find the cause of your depression symptoms.

In addition, the doctor can use the following types of tests:

The Beck Depression Rating Scale is a 21-question test that will allow your doctor to determine the severity of depression symptoms.

The Tsung Depression Self-Rating Scale is a short test that measures the severity of depression from mild to severe.

The Depression Epidemiological Research Center scale is a test that allows the patient to assess their feelings, behavior and worldview in terms of the past week.

During the passage of these tests, you may hesitate to honestly answer the questions. In the tests, you will find questions about depression and mood, depression and ability to learn, physical manifestations of depression, such as decreased vitality, sleep problems, or sexual dysfunction. Regardless, try to answer the questions as honestly as possible. This will help the doctor make an accurate diagnosis and prescribe the most effective treatment.

What to do if the doctor has diagnosed depression?

Remember, depression is curable. Therefore, being diagnosed with depression will help you get on the path to recovery and put aside feelings of helplessness, hopelessness, and worthlessness.

If you have been diagnosed with depression, follow all your doctor's advice to improve your condition. It is very important to take prescribed medications. You should also do everything you can to change your lifestyle and attend psychotherapy sessions. Millions of people around the world suffer needlessly from this disease simply because they do not receive appropriate professional help, which begins with a diagnosis.

Are you suffering from severe depression? Are you wondering how a doctor can make a correct diagnosis?

In the past, it was customary to treat mood disorders collectively. Today, the doctor identifies a particular disease, according to the symptoms of its manifestation. For example, when making a diagnosis, the doctor will determine what type of depression you have, acute depression, dysthymia or chronic depression, seasonal affective disorder, bipolar disorder (manic depression), or some other type of depression.

How does a doctor make a diagnosis?

There are doctors who use special blood tests or other expensive laboratory tests to make a diagnosis. However, these tests, when diagnosing depression, do not give the desired result and do not help to make a correct diagnosis. At the same time, talking with the patient is actually the most effective method for diagnosing depression.

To make a correct diagnosis and prescribe an effective treatment, the doctor must hear what symptoms the patient has. While physical tests can help determine a patient's general health, talking to them can help the doctor know about other factors that are important in diagnosing depression. For example, in a conversation, the patient will tell the doctor about the mood throughout the day, about behavior and life habits.

Diagnosing depression is challenging because acute depression manifests itself in a variety of ways. For example, some people with acute depression fall into a state of apathy. Others become irritable or even overexcited. There are problems with sleep and appetite. A sick person may overeat heavily, sleep for a very long time, or refuse to eat or sleep at all.

External or behavioral symptoms of depression may be minimal, while internally a person experiences deep turmoil. Depression is a dangerous and all-encompassing disorder that affects the body, feelings, thoughts and behavior of a person.

What does the doctor look for when diagnosing depression?

Having made a general examination of the patient, talking with him and conducting certain laboratory tests, the doctor will exclude diseases that cause depression. He will perform a complete diagnostic evaluation of your condition and ask you about depression in your family. The doctor will assess the manifestation of the symptoms of the disease, including the period of their onset and duration and methods of treatment. Your doctor will ask you how you feel and especially if you have any of the following symptoms of depression:

persistent feeling of sadness, anxiety, or emptiness
complete indifference to once loved activities (anhedonia)
feelings of helplessness, guilt, or worthlessness
increased tearfulness, hopelessness and pessimism
fatigue and loss of vitality
forgetfulness, difficulty concentrating, or inability to make decisions on your own
restlessness and irritability
sleep problems
appetite swings or sudden weight changes
persistent physical symptoms that do not respond to treatment (especially pain or indigestion)
suicidal thoughts or attempts to commit suicide
low self-esteem (eg, verbal self-flagellation)

How are symptoms of depression assessed when diagnosing depression?

To make a diagnosis of depression, one of the first two symptoms and five of the other symptoms of depression induced above must be present. They should last daily for two weeks.

Symptoms of depression can take months or even years to appear. They cause changes in a person's personality characteristics and performance, as a result of which other people cease to sympathize with him. Some symptoms have such a strong impact on life that they do not allow them to fully function and live. In the most severe cases, patients are unable to eat or get out of bed.

Symptoms of depression may occur only once in a lifetime or be repetitive, chronic and long lasting. In some cases, it seems that they will never go away. In other cases, they appear selectively.

Very often, depression occurs as a result of a chronic disease, such as cancer or heart disease, and in most cases worsens the condition of the patient.

Are there physical signs of depression?

Although there are no specific physical manifestations of depression, there are certain physical disorders that signal the possibility of depression:

preoccupied look
The person does not make eye contact when speaking.
Memory loss, difficulty concentrating, loss of ability to think logically
Stimulation, arm ache and hair loss
Psychomotor retardation or agitation, such as slow speech, breathing, and long pauses in conversation
Self-judgmental behavior or belligerent and defiant behavior (especially in adolescents)
Slow movements, sometimes developing into complete immobility or a state of catatonia
Increased tearfulness or sad facial expression

What laboratory tests are used to diagnose depression?

After analyzing all examinations, interview results, the patient's medical history and genetic predisposition, the doctor may order additional laboratory tests to rule out the possibility of a more serious physical disease. For example, a decrease in thyroid function causes the manifestation of symptoms of depression. Your doctor will also ask you what medications you are taking and ask you to take a urine test.

How can I help the doctor make the correct diagnosis?

Before you see your doctor, make a list of all the questions you have about depression and a list of any symptoms that come up. Also talk to relatives and find out what diseases you have a genetic predisposition to. This will help the doctor make an accurate diagnosis and prescribe effective treatment. Before you visit your doctor, consider and write down the following:

Concerns about mental and physical health
Symptoms you have noticed
Describe your usual behavior
Diseases you have had in the past
Family history of depression
Medicines you are taking now or in the past, including prescription and over-the-counter medicines
Unusual side effects of drugs you are taking or have taken
Supplements you are currently taking
Describe your lifestyle (exercise, diet, smoking, drinking, drug use)
Describe your dream
Stressful life events (related to marriage, work or society)
Questions about depression and medications that interest you

The word depression (from Latin depressio - suppression, oppression, melancholy) is often understood as a bad mood. However, in medicine, this term refers to a serious mental illness that affects not only emotions, but also thinking and behavior and can lead to serious consequences and even death.

The danger of depression is that people often take it for ordinary apathy, weakness, do not want to see a doctor, hoping to cope with their condition on their own. However, this is not just a dreary mood or fatigue. With depression, a person loses vitality, interest in what used to bring joy, and can hardly cope with daily activities. He cannot just throw sad thoughts out of his head, switch to something pleasant, rest does not cause a surge of strength. Depression is a serious disease, such as diabetes mellitus or hypertension, that requires long-term complex treatment. With the right selection of drugs and psychotherapeutic support, many patients feel much better.

Russian synonyms

Unipolar disorder, unipolar depression, major depressive disorder, clinical depression, major depressive episode.

English synonyms

Recurrent depressive disorder, clinical depression, major depression, major depressive disorder, major depressive episode, unipolar depression, unipolar disorder

Symptoms

In general, depression is manifested by the so-called depressive triad. This means that three components suffer: emotions, thinking, motor skills (motor activity). They are oppressed, suppressed, which leads to a number of characteristic manifestations of depression:

Changes in the emotional sphere are manifested in a low mood, a feeling of melancholy, sadness, emptiness. The patient becomes tearful for no reason, loses interest in life, does not feel pleasure from what used to bring joy. Children, on the contrary, can be irritable, stubborn, capricious.
The weight is changing. Most often, patients lose weight, refuse food, do not enjoy food, do not feel the taste. However, increased appetite is also possible.
Sleep is disturbed. A person sleeps too much, while feeling, on the contrary, a lack of sleep. Conversely, insomnia is also possible.
Movement is slowed down. A person does everything slowly, with visible effort, as if losing energy. Mournful expression. With some types of depression, anxiety and restlessness appear.
Difficulties arise in concentration, memory deteriorates, the flow of thoughts seems to slow down.
Very often, the patient unreasonably experiences a sense of guilt, his own inferiority. He considers himself worthless, useless, useless.
It is not uncommon for patients to have suicidal thoughts.

The diagnosis of major depressive disorder is based on the presence of such symptoms for at least 2 weeks.

With prolonged depression, it is possible to add psychotic deviations, that is, delusions, hallucinations.

Depression in children and the elderly often takes a slightly different course. In children, disturbances in appetite and sleep come to the fore, nightmares appear. The child becomes capricious, aggressive, naughty. Problems appear in studies and communication with peers, interest in games disappears. Elderly people in a depressed state become irritable, grouchy, stop communicating with relatives and friends, experience unreasonable anxiety, concentrate on ideas of self-blame and worthlessness of their lives.

General information about the disease

To explain the causes and mechanisms of the development of depression, the monoamine theory is now the most popular. Monoamines are the three most important chemicals (neurotransmitters) in the brain: serotonin, norepinephrine, and dopamine. Serotonin affects well-being, mood, appetite, sleep, libido. Norepinephrine has a general activating effect, is responsible for changing the periods of sleep and wakefulness, affects memory, attention, and thinking. Dopamine is responsible for behavior and movement.

With depression, the amount of basic monoamines in the brain decreases, which leads to suppression of emotions, thinking and motor activity, sleep and appetite disorders.

There are other opinions regarding the mechanisms of development of depression, for example, the cytokine theory, the influence of female sex hormones, etc.

There are two main types of depression - endogenous and reactive. With reactive depression, which is caused by stress - the loss of a loved one, violence, difficulties at work or in relationships with loved ones - as a result of stress on the nervous system, changes in the biochemistry of the brain occur and the amount of monoamines decreases. If there is no reason that could cause changes, then such depression is called endogenous, that is, coming from within. In both cases, hereditary predisposition is of great importance. Active searches are now underway for the gene responsible for the development of depression.

It is important to understand that major depressive disorder is an independent disease that has certain psychological and biological mechanisms of development. However, there is the so-called somatogenic depression - it is the result of a number of diseases and does not apply to major depressive disorder. Diseases of the endocrine system (hyper- and hypothyroidism, Cushing's disease, hormonal changes in the postpartum period), diseases of the nervous system (Parkinson's disease, epilepsy, traumatic brain injuries, strokes, brain tumors), cardiovascular diseases, oncological diseases can lead to somatogenic depression. diseases, avitaminosis.

Often, depressive symptoms are the result of certain medications (eg, propranolol, indomethacin, metoclopramide, cycloserine, vincristine) or alcohol abuse.

When the underlying cause is eliminated, the symptoms of somatogenic depression disappear.

Who is at risk?

Women. The percentage of women among patients with depression is higher, which can be explained both by the level of estrogen and by the greater psychological vulnerability of women, a tendency to experience.
People who have relatives with depression.
Those who have experienced stress - the loss or illness of a loved one, loss of work, frequent quarrels in the family, violence, especially in childhood, violations of parent-child relationships.
People experiencing lack of sleep, rest, heavy workloads.
Suffering from severe chronic diseases.
Taking medications that can cause depression.
Alcohol abusers or drug users.
People without friends and relatives.

Diagnostics

Diagnosis is based, first of all, on the identification of the main symptoms during the doctor's conversation with the patient himself and his relatives. When examining a patient, special attention is paid to the state of the nervous and endocrine systems, since the doctor must exclude a number of diseases that can cause depression.

Additionally, a general and biochemical blood test is usually prescribed to determine the main blood electrolytes, urea levels, creatinine, bilirubin, etc. This is necessary to identify possible metabolic disorders, liver and kidney diseases, anemia, and infections. You should also exclude alcohol poisoning or other psychoactive substances, HIV, beriberi, Cushing's disease, Addison's disease, thyroid disease, as the most common organic causes of depressive symptoms. There are no specific laboratory tests to diagnose depression.

Treatment

At the moment, there are a number of fairly effective drugs - antidepressants that affect the metabolism of monoamines, restoring their amount in the brain. The selection of antidepressants is a long and complex process. The choice of treatment regimen depends on how depression proceeds in each individual patient, what symptoms predominate, and whether there are concomitant diseases. Psychotherapeutic help is of great importance - both individual and in a group. Communication with a psychotherapist or psychologist allows the patient to understand the mechanisms of development of depression, its symptoms, helps to deal with difficult life situations for him, build relationships with other people correctly, and more easily cope with the negative symptoms of the disease. All this, combined with the right medications, gives results.

Since symptoms of depression (eg, fatigue, sleep disturbances) are found in many diseases, the examination of a depressed patient should include the usual laboratory tests: general and biochemical blood tests, urinalysis.

Metabolic disorders also lead to depression, so it is necessary to determine the level of TSH and the serum concentration of vitamin B12. Unfortunately, these studies can only identify or rule out diseases that may be hiding under depression or exacerbate it.

There are no laboratory methods for detecting depression yet. CT, MRI, EEG, lumbar puncture are performed only in special cases, when their need is due to the data of anamnesis or physical examination.

Patients over 40 years of age should have an ECG. It will reveal violations of the rhythm and conduction of the heart, however, this does not help differential diagnosis.

Special tests for symptoms of depression (Tsung Depression Scale, Beck Depression Scale, etc.) make it possible to suspect depression and monitor its dynamics. But these tests do not help make a diagnosis, but only determine the severity of the symptoms.

PHQ-9 test for depression

The first reliable test for mental disorders is the PHQ-9 health assessment questionnaire (test for the diagnosis of depression), which the patient fills out himself. It not only helps in diagnosis, but also quantifies the severity of symptoms, making it possible to judge the effectiveness of treatment.

The patient is asked to answer the questions: "Have you been bothered by the following problems during the last two weeks." Each question has four possible answers and a score:

Not every day (0 points)
Several days (1 point),
More than half the days (2 points),
Almost every day (3 points).

After answering the questions, all points are summed up. So test.

In the past two weeks, have you experienced:

Lack of interest in current events?
Indifference, depression?
Trouble falling asleep, insomnia, sleeping too much?
Feeling tired or lack of energy?
Lack of appetite or overeating?
Do you feel like a failure, blame for burdening your family?
Difficulty concentrating on reading or watching TV?
Are you moving or talking unusually slowly (slowness), or are you agitated, moving more than usual?
Thoughts of suicide or self-harm?

Overall score/Severity of depression.