Depression is a common but heterogeneous mental health disorder. Symptoms of depression may be typical or masked and far from characteristic. The professional diagnosis of depression takes not only the symptoms into account, but also the results of diagnostic tests, the patient’s life context and these health conditions that can produce symptoms resembling depressive ones. Early and accurate diagnosis makes it possible to deal with the problem and reduces the negative impact that depression has on the patient’s health and life.
When is depression diagnosed?
Depression is diagnosed when there are indications for it, e.g. symptoms reported or observed in the patient. The prevalence of depression in the whole population is high, moreover, it increases in the case of certain diseases, e.g. cancer, heart attack or stroke. Therefore, there are recommendations for screening for depression for any patient who is not receiving antidepressant treatment. Family doctors can use patient health questionnaires PHQ-2 and PHQ-9 for this purpose, which allow the initial diagnosis of depression in adults and the degree of its severity. These are simple methods, and they do not take much time to complete, so questions from the questionnaire can be asked routinely during the patient’s visit to the GP. The Geriatric Depression Scale (GDS) is used to screen for depression in the elderly . It should be borne in mind that scales and questionnaires are diagnostic guidelines that, for a comprehensive diagnosis, should be supplemented with a wider history.
Who diagnoses depression?
A suitably qualified person deals with the professional diagnosis of depression. Regulations in the health care system of a given country determine, who can deal with the diagnosis of the disorder. The diagnosis of depression can be made by a psychiatrist as well as a primary care physician (GP). Psychologists can help diagnose depression by conducting appropriate tests and interpretations, but do not provide treatment. The psychotherapist treats people with depression, but cannot make an official diagnosis. It is rare that one person combines several mental health specialties, but if this is the case, then, of course, their scope of competence will be wider and may include diagnosis, treatment and psychotherapy. The recommended model of care is cooperation between specialists. Although a visit to a psychiatrist does not require a referral and prior appointment with a GP, which can be considered as facilitating access, the patient’s fear of stigmatization can constitute an obstacle. In addition, the objectively existing obstacle is the insufficient number of psychiatrists constituting a limitation in access to their services. The list of the Central Register of Physicians of the Republic of Poland belonging to the Supreme Medical Council shows that there are 4,600 psychiatrists practicing in Poland (2023 data). Training a specialist is a long-term process, and the growing number of patients poses challenges here and now. That is why, among other things, the recommendation of the Polish Psychiatric Association is that general practitioners provide assistance in diagnosing and treating depression in their patients. This places additional requirements on the GP, but may improve the effectiveness of the treatment carried out so far. It is worth knowing that general practitioners can diagnose and treat mild to moderate depression.
When to consult a psychiatrist in case of depression?
Some situations require psychiatric consultation. The help of a psychiatrist should be used when the help of a general practitioner is insufficient or when the general practitioner does not feel experienced enough to provide it. According to the guidelines of the Polish Psychiatric Association on the management of depression in adults for family doctors, patients should be referred to a psychiatrist for consultation if:
- they are at risk of suicide (urgent psychiatric consultation),
- they suffer from severe and chronic depression,
- their depression is drug-resistant,
- there are increased side effects of antidepressants,
- there is a history of bipolar disorder in their closest family,
- if they have issues with addiction,
- depression affects a pregnant woman.
A visit to a psychiatrist is needed if the depression is so deep that it temporarily prevents you from working. If there is justification, the psychiatrist has the opportunity to issue a certificate of temporary incapacity for work due to depression.
How is depression diagnosed?
In people with suspected depression, the recommended diagnosis includes a thorough interview and functional assessment of their life, professional and family situation. The collected history concerns the occurring symptoms (duration and severity), comorbidities, currently taken drugs and other substances, and possible previous treatment. The interview may also include a conversation with the patient’s family. The diagnosis of depression is based on the diagnostic criteria for depression described in the ICD-10 International Classification of Diseases created by the World Health Organization (WHO) and the manual containing diagnostic criteria for mental disorders DSM-5 created by the American Psychiatric Association. Specialists use symptomatic questionnaires, but these are only auxiliary tools. The popular Beck Depression Inventory offers a guide for the physician – still the result of the patient’s self-assessment test cannot replace a thorough interview. There are no laboratory or imaging tests that can clearly confirm depression. Your doctor may order tests because they form an important part of differential diagnosis. Symptoms attributed to depression may occur in other health problems, e.g. anaemia, vitamin deficiencies, infectious and parasitic diseases, hormonal changes. Full diagnosis of depression consists in excluding other possible causes – i.e. somatic and mental diseases with similar symptoms. The bipolar disorder (PD), which is sometimes misdiagnosed as depression, among others because periods of mania are overlooked by the patient, and the patient goes to the doctor during the period of predominance of depressive symptoms may be used here as an example of difficulties encountered in diagnosing depression. The diagnosis of depression is also hindered by symptoms that manifest themselves in a subtle manner. Contrary to appearances, the correct diagnosis of depression is not easy and may be a process that requires several meetings. It is worth paying attention to your condition, but it should be remembered that self-diagnosis requires further consultation with a specialist, and the symptoms do not necessarily indicate a mental health disorder. You can find information about the symptoms of depression in the present article.
What should follow a diagnosis of depression?
If depression is diagnosed, the patient should be informed about the diagnosis, as well as about the possibilities of further treatment. The choice of therapeutic options should take into account the patient’s preferences, and also the availability and safety of the method. Treatment requires frequent monitoring of patient’s condition. Treatment of depression may include pharmacotherapy and/or psychotherapy. Alternative treatment may be evidence-based virtual therapy with use of the VR TierOne medical device. Measuring tools such as the Geriatric Depression Scale (GDS) were used to assess depression in people participating in the study of the effectiveness of VR TierOne virtual therapy combined with the Hospital Depression and Anxiety Scale ( HADS). You can read about the possibilities of testing for depression, but also anxiety and stress on the VR TierOne blog. Take a look here.
