Adult Psychiatry
Depression - Symptoms and Diagnosis
We often hear about depression, but it's not as simple as just feeling unhappy. Gaining more knowledge about depression can be helpful in case you experience some of its symptoms yourself. This awareness may allow for quicker detection and reduce the likelihood of delaying treatment.
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Is Unhappiness the Same as Depression? 4 Factors Doctors Consider for Diagnosis
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Psychotic Depression: Differentiating Between Depression and Psychosis
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Is It Depression or Something Else? Physical Conditions That Can Mimic Depressive Symptoms
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Treatment-Resistant Depression: Is There No Cure When Medications Don't Work?
Unraveling the Symptoms of Depression
Depression is a term that most people have heard, but it is more complex than simply feeling unhappy. Understanding more about the symptoms of depression can help individuals recognize when they or someone they know may be experiencing them, potentially reducing delays in seeking appropriate treatment. In this article, we will discuss the four main categories of depression symptoms:
Emotional Symptoms
When experiencing depression, a person's emotional state can become incredibly low and unhappy. This persistent unhappiness typically lasts longer than general sadness and must continue for at least two weeks to meet the diagnostic criteria for depression. Additionally, individuals with depression often lose motivation and interest in activities they once enjoyed. They may also appear consistently fatigued, exhibiting a lack of energy and enthusiasm.
Physical Functioning
Depression can negatively impact our daily physical functioning. Sleep disturbances are common, with individuals either struggling to fall asleep, waking up earlier than usual, or sleeping excessively. Appetite changes may also occur, leading to weight fluctuations. Some people with depression may move more slowly than usual and participate less in outdoor activities or social events.
Cognitive Functioning
Cognition refers to the thoughts that occupy a person's mind. Depression can affect one's thinking patterns, leading to differences in thought processes compared to their non-depressed state. Even those who are usually confident may experience low self-esteem when depressed. They might engage in self-blame or feel guilty for no apparent reason, shouldering responsibility for issues that aren't their fault. Some individuals may struggle to concentrate or even experience suicidal thoughts.
Sensory Symptoms
Emotions can also influence a person's sensory experiences. Sometimes, patients may not complain to their doctor about feeling emotionally low or unhappy. Instead, they may repeatedly report physical discomfort, such as chest pain, muscle aches, or digestive issues. These individuals often don't associate their symptoms with depression but instead believe they are related to a physical illness, seeking referrals to various specialists. Unfortunately, in many cases, numerous examinations fail to identify a specific cause for their discomfort.
Common sensory symptoms include pain, muscle aches, fatigue, dizziness, numbness, neck pain, and lower back pain. These physical discomforts can further impact daily life, affecting appetite, daily activities, and sleep.
In conclusion, depression symptoms are not limited to emotional lows. If you suspect that you or someone you know is experiencing symptoms of depression that are affecting daily life, it is crucial to consult a professional for evaluation as soon as possible.
Is Unhappiness the Same as Depression? 4 Factors Doctors Consider for Diagnosis
Many people have heard of depression, but what exactly constitutes this mental health condition? Is extreme unhappiness, constant sadness, or frequent crying considered depression? Is the pain after a breakup with a partner indicative of depression? How do doctors usually determine whether a person is suffering from depression?
In fact, doctors typically consider four factors when deciding whether an individual has depression:
Number of Depression Symptoms
The more depression symptoms a person exhibits, the higher the likelihood of them having depression. Common symptoms include persistent low mood, lack of motivation, decreased self-confidence, and reduced sleep quality. Doctors will evaluate the severity of a patient's depression by counting the number of these symptoms.
Types of Depression Symptoms
Certain symptoms are more commonly seen in severe cases of depression. For example, psychomotor retardation is a condition where the patient's movements are noticeably slow, making them appear as if they are breaking down. Some severely depressed individuals may also exhibit symptoms of psychosis, such as hearing nonexistent voices, seeing nonexistent images, or constantly suspecting that others are plotting against them. These types of symptoms reflect the severity of depression.
Impact of Depression Symptoms on Life
For some patients, depression significantly reduces their quality of life. They may be unable to attend school or work, preferring to stay at home and avoid any activities. Their social lives and relationships with family members may also suffer as a result of their depression.
Duration of Depression Symptoms
While everyone experiences unhappiness from time to time, transient sadness is not considered depression. On the contrary, if symptoms persist for an extended period, such as several weeks or even months, the situation might be more severe.
If you recognize any of these symptoms in yourself or someone close to you, please pay attention to these four factors. If the situation seems similar, it is advisable to seek medical help and treatment as soon as possible.
Dysthymia: The Gray Area Between Normal and Depressed
In a previous discussion, we mentioned that doctors diagnose depression based on four different dimensions, including the number, duration, type, and severity of depressive symptoms.
However, some individuals may experience consistent unhappiness without meeting the diagnostic criteria for depression. Their symptoms might be relatively mild, such as persistent low mood or reduced appetite, and may not significantly impact their lives. So, should these individuals be considered depressed or not?
In fact, diagnostic guidelines include other conditions to describe patients who fall into the gray area between depression and normal mental health. One such condition is called Dysthymia.
Compared to patients with major depression, individuals with Dysthymia have milder symptoms but experience them for a more extended period. To be diagnosed with Dysthymia, a patient typically needs to have experienced symptoms for at least two years.
The treatment approach for Dysthymia is similar to that for depression, with doctors often prescribing antidepressant medications to alleviate symptoms. However, clinical experience suggests that patients with Dysthymia may benefit more from addressing underlying emotional issues and learning to view the world from a different perspective.
Psychotic Depression: Differentiating Between Depression and Psychosis
Sometimes, patients with depression may experience symptoms of both depression and psychosis. In such cases, they might be diagnosed with psychotic depression.
Psychotic depression can be understood as a subtype of severe depression. Many patients with severe depression may exhibit symptoms of psychosis, but most of these cases are still classified as depression rather than schizophrenia or other psychotic disorders.
So, how can we differentiate between depression and psychosis when patients exhibit symptoms of both?
First, we can consider the timeline of symptom onset. In patients with psychotic depression, depressive symptoms usually appear first, followed by psychotic symptoms later on. In contrast, patients with schizophrenia or other psychotic disorders often initially experience psychotic symptoms such as hallucinations or delusions. Their emotional symptoms usually arise as a result of the distress caused by these psychotic symptoms.
Second, we can examine the type of psychotic symptoms present. In psychotic depression, the psychotic symptoms are typically mood-congruent, such as delusions of persecution or nihilism. Conversely, the psychotic symptoms in patients with psychotic disorders are more diverse and may not necessarily be mood-congruent.
Third, some patients with psychotic depression may experience an alleviation of psychotic symptoms after undergoing antidepressant treatment. In contrast, patients with psychotic disorders often continue to experience depressive symptoms even after taking antidepressant medications.
How should psychotic depression be treated, and is the treatment approach similar to that for depression?
The treatment for psychotic depression differs from that for regular depression. Patients generally require higher doses of antidepressants, and the treatment duration is typically longer than that for regular depression.
In addition to antidepressants, patients may also need to take antipsychotic medications to control their psychotic symptoms. Generally, the dosage of antipsychotic medications for patients with psychotic depression is lower than that for patients with schizophrenia.
However, many cases of psychotic depression are also classified as treatment-resistant depression. In addition to antidepressants and antipsychotic medications, patients may need to undergo other treatment modalities, including transcranial magnetic stimulation, esketamine, or electroconvulsive therapy.
Depression or ADHD? How to Handle Doubts About Misdiagnosis
Depression symptoms can be divided into four main categories, one of which concerns a patient's cognitive function. Depression can impact a person's thought patterns as well as their ability to concentrate and short-term memory.
However, children with Attention Deficit Hyperactivity Disorder (ADHD) often experience depression due to the impact of their symptoms on learning and work. In fact, individuals with ADHD have a higher chance of developing depression compared to the general population.
In previous generations, the concept of ADHD was not well understood, and many individuals with ADHD went undiagnosed even into adulthood. When a patient presents with symptoms of both inattention and depression, how should a doctor make a diagnosis?
Case Study
(Adapted from a forum post)
"I've always struggled with inattention, which has affected my work performance, leading to anxiety and depressive symptoms. After seeing a doctor, I was diagnosed with depression and told I don't handle stress well. However, I believe that my underlying issue is inattention, as it affects my work abilities, lowers my self-confidence, and makes me avoid contact with others. The doctor insists that I have depression and that my inattention is just one of the symptoms. My opinion differs from the doctor's. How should I handle this situation?"
Which Came First: The Chicken or the Egg?
To determine whether a patient has depression or ADHD, the timeline of ADHD symptoms is crucial. If the patient's inattention symptoms were present during childhood, the diagnosis is more likely to be ADHD.
However, this determination can be difficult in practice. We cannot go back in time, and it's hard to judge whether a patient had ADHD during childhood based on a brief conversation. In such cases, doctors may need to involve the patient's family members during the consultation to provide additional information to aid in diagnosis.
What Should I Do If My Doctor Isn't Listening to My Concerns?
If you are attending a follow-up appointment at a public hospital, you can ask your doctor for a referral to an adult ADHD clinic, such as the one at the David Trench Rehabilitation Center. This clinic accepts suspected cases from all regions, but the waiting time may be longer.
If you are attending a follow-up appointment at a private clinic, the solution is simpler: consider changing doctors to address your concerns.
Is It Depression or Something Else? Physical Conditions That Can Mimic Depressive Symptoms
Before being diagnosed with depression, patients must meet certain diagnostic criteria. However, sometimes even when all criteria for depression are met, the patient may not actually have depression. In fact, many other physical conditions can produce symptoms similar to those of depression.
Thyroid Dysfunction
When we see a new patient, we usually perform blood tests after reviewing their medical history. One of the blood tests checks for thyroid hormones. This is because endocrine problems, such as hypothyroidism, can cause symptoms similar to those of depression, including fatigue, lethargy, and weight gain. Addressing these endocrine issues can alleviate the so-called depressive symptoms.
Cancer and Chronic Infections
What other physical conditions can cause depressive symptoms? Imagine a body constantly at war; every cell would be exhausted, with little energy left for daily tasks. Under such circumstances, a person may become fatigued, lethargic, and lose weight, resembling a patient with depression.
Conditions that put the body in a constant state of battle include cancer and long-term infections, such as syphilis, HIV, and tuberculosis.
Anemia
Why would anemia cause depressive symptoms? Hemoglobin in the blood supplies oxygen to every cell in our body. Through chemical reactions, the energy from glucose and fatty acids in food can be released, allowing our bodies to function normally.
Anemic patients have insufficient hemoglobin to supply their cells with enough oxygen, making them appear fatigued and lethargic, unwilling to socialize or go out. This closely resembles depression.
There are many causes of anemia, such as iron deficiency and excessive blood loss. Irregular or heavy periods can lead to anemia in some women, while folate or vitamin B deficiencies can also contribute.
As mentioned earlier, insufficient oxygen supply can result in pseudo-depressive symptoms. Apart from anemia, some cardiovascular and respiratory diseases may also be potential causes.
Other Neurological Disorders
Depression originates in the brain, so it's intuitive to think that other brain-related issues might affect cognition and emotions, leading to depressive symptoms. Some neurological disorders, such as Parkinson's disease or Alzheimer's, can also present with symptoms of depression.
Treatment-Resistant Depression: Is There No Cure When Medications Don't Work?
According to the general definition, if a patient has tried two different classes of antidepressant medications and their depressive symptoms still persist, they may be suffering from treatment-resistant depression (TRD).
Other Possibilities for Treatment-Resistant Depression
However, sometimes the situation is not so simple. To determine if a patient has TRD, doctors must first ensure that the patient is adherent to their prescribed medications. If the patient does not take their medication, how can the condition be considered resistant to treatment?
Moreover, doctors need to know if the patient has previously taken an adequate dose of antidepressants and for an appropriate length of time. Antidepressant medications generally take at least one to two weeks to show any effects. If a patient gives up after just a few days, the efficacy of the medication cannot be accurately assessed.
Sometimes, other physical conditions can cause depression, such as anemia or hypothyroidism. If these underlying issues are not resolved, taking antidepressant medications may not alleviate depressive symptoms.
Additionally, other mental health conditions can cause symptoms of low mood, such as schizophrenia or personality disorders. The treatment methods for these conditions differ from those of depression, and relying solely on antidepressant medications may not provide any help for these patients.
Treatment for Treatment-Resistant Depression
Treatment-resistant depression does not mean untreatable depression. With patience, a solution can be found. Besides switching to a different antidepressant medication, some doctors may try other types of psychiatric medications, such as antipsychotics or mood stabilizers. In addition to medications, electroconvulsive therapy (ECT), and newer treatment methods like repetitive transcranial magnetic stimulation (rTMS) and the glutamate-based medication esketamine, can also be used to treat treatment-resistant depression.