Rashmi Nemade, Ph.D., edited by Kathryn Patricelli, MA
Interviews, Questionnaires, and Diagnosis
Before a clinician can successfully treat depression, he or she must first accurately make a diagnosis. There are different kinds of depression, which respond to different types of treatments. What works for one sort of depression may not work for another, or might even prove harmful. Only by first making an accurate diagnosis can the doctor figure out what treatments are likely to help.
Making an accurate diagnosis of depression can be complex. It requires your doctor to create a comprehensive and accurate picture of current functioning by assessing current and past medical and psychological functioning and symptoms.
Often, the diagnosis process starts with a visit to a primary care doctor. The doctor may ask simple questions about feelings and experiences. A physical exam, medical history and lab tests will help to determine if the depression is related to a physical condition. If a biological cause for the depression is eliminated, the primary care doctor may prescribe an antidepressant medication or refer the patient for a psychological evaluation by a psychiatrist, psychologist, or other mental health specialist doctor.
When possible, it is often a good idea to meet with a mental health specialist before beginning a specific depression treatment such as antidepressants. Although primary care doctors are incredibly competent, they are ultimately generalists. They are simply not trained to differentiate between the many different types and causes of depressive disorders. In addition, they may not be up to date regarding the latest information on the most effective psychotherapy and medication options. As a result, primary care doctors are a good starting point, but they should not be the only resource for diagnosis and treatment.
The sort of mental health specialist that is seen will in part determine the way that specialist will tend to understand the depression and attempt to treat it. Most psychiatrists specialize in the use of medications to treat mental illness. Only a small number of psychiatrists are well trained as therapists these days. Psychologists specialize in offering psychotherapy for mental illness, but typically cannot prescribe medication, except in a few locations. Other trained mental health professionals such as psychiatric nurses, clinical social workers, and counselors can also provide psychotherapy as well. It may be most convenient to work with both a psychiatrist and some other sort of psychotherapist at the same time in order to benefit from both medication and psychotherapy treatments.
Any specialist will want to perform one or more face-to-face interviews to get a good handle on the diagnosis. During these interviews, the clinician's goal is to learn more about:
current problems and symptoms,
a complete history of previous symptoms
a family history
a history of significant stressful life events (psychosocial stressors),
information concerning lifestyle, culture, social support structure
any alcohol or drug use
any suicidal thoughts or tendencies the person may be experiencing.
Patients may also be asked to answer questions designed to measure "mental status." This could include questions about the degree to which they are alert and oriented and display normal speech, their attention and concentration abilities, and memory and problem solving skills.
The two most critical factors that the clinician will use to determine whether or not the person is suffering from clinical depression will be: 1) the degree to which symptoms interfere with daily life and functioning, and 2) how long the symptoms have lasted. In order to compare symptoms to those of other people so as to determine your symptom severity, you may be asked to complete one or more formal standardized questionnaire tests such as:
the Hamilton Depression Rating Scale
Montgomery-Åsberg Depression Rating Scale
Raskin Depression Rating Scale
the Beck Depression Inventory
Geriatric Depression Scale (if you are 65 years of age or older)
the Zung Self-Rating Depression Scale
The Patient Health Questionnaire
the Center for Epidemiologic Studies Depression Scale Revised.
These questionnaires are useful for screening purposes and as research instruments, but are they are not the only source of information used to make a diagnosis.
Many times, self-report questionnaires can be found on-line. While it is fine (and even a good idea) to use such on-line tests to keep track of depression, it is important for people to avoid the temptation to use the results from these instruments to diagnose themselves solely on the basis of their score. Accurate diagnosis can only come from a mental health professional after careful review of all results from a full diagnostic process.