Sadness touches all of our lives at different times, but depression can have enormous depth and staying power. It is more than a passing bout of sadness or dejection, or feeling down in the dumps. It can leave you feeling continuously burdened and can sap the joy out of once-pleasurable activities. It has physical, as well as emotional, symptoms. You may find that you can't sleep or eat, that you are fatigued, or that you have headaches or aches and pains that seem to have sprung up without a cause.
Although depression is by no means a silent disease, it is substantially underdiagnosed. Experts estimate that only one-third of those who have major depression get the help they need.
When people do reach out for help, doctors typically diagnose depression by asking about feelings and experiences. They may also use screening tools and look for possible medical causes by performing a physical exam and sometimes ordering lab tests.
A physical exam and medical history may offer clues that point to depression caused by medication or an underlying illness. In these cases, blood tests or x-rays may confirm the problem. Often, when people are unable or unwilling to recognize their own depression, their initial complaints are medical. Headaches, stomach problems, sexual difficulties, and lack of energy are among the more common medical complaints.
If your symptoms suggest depression and medical causes seem unlikely, your doctor will be interested in hearing whether you've had any feelings of sadness or hopelessness and whether you've noticed any changes in your appetite, sex drive, or sleep patterns. He or she may also ask these questions:
- Have you or anyone in your family ever suffered from depression or another mental disorder? If so, how was it treated?
- Do you get satisfaction and pleasure from your life?
- Do you ever have thoughts about suicide or have you attempted suicide?
- Do you drink alcohol? If so, how often and how much?
- Do you use any drugs such as marijuana, cocaine, crack, or heroin to get high or relax? If so, which drugs and how often?
Your caregiver might ask you to complete a checklist that may pick up some symptoms or subtle mood changes that otherwise might not be identified. Alternatively, the clinician may complete a similar scale based on his or her observations; such scales are slightly better at detecting depression than self-reports.
Because you may minimize symptoms or may not even be aware of them, your doctor or therapist may want to speak to someone close to you. Where a child or teen is concerned, the doctor may interview parents and teachers or a guidance counselor.