Reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Depression, feeling down, the blues, hopelessness, sadness you can’t shake — these are just some of the ways you might describe what healthcare professionals define as depression.
However, depression is more than just feelings of sadness and more nuanced than the ways we describe it, so how do healthcare pros actually diagnose it? What do they look for? What different types of depression are there and how do they show up?
Let’s dig in.
Depression is more than just feeling down — it’s a mood disorder that shows up as prolonged depressive feelings and impacts your day-to-day. Healthcare professionals diagnose depression typically based on symptoms and sometimes different scales created to measure depression.
When a healthcare provider or mental health professional assesses depression symptoms, they often look to see if patients are:
Feeling sad or anxious
Feeling hopeless or have feelings of hopelessness
Feeling irritable or frustrated
Feeling “empty” or disconnected
Feeling a lack or loss of energy
Feeling a loss of interest in things that were once pleasurable
Having trouble concentrating
Having trouble sleeping
Lack of appetite
Extreme appetite and weight gain
Physical aches or pains with no physical illness
Suicidal thoughts or suicide attempts
These common symptoms aren’t the same for everyone, but often, people experience multiple symptoms for varying amounts of time.
And if you’re concerned about any of these depression symptoms, please talk with your healthcare provider about your questions, worries and signs of depressive episodes.
Typically, to be diagnosed with any type of depressive disorder — including mild depression and major depression — you must show at least five depressive symptoms every day for at least two weeks.
To assess your symptoms and diagnose depression, some healthcare professionals may use different screens or scales.
They’re also likely to use a lab test to rule out any other medical conditions that may cause similar symptoms. The three standard scales used are the Beck Scale, the Hamilton Scale and the Montgomery-Asberg Depression Rating Scale.
First, your healthcare provider is likely to run some blood tests and lab work. This isn’t actually used to diagnose depression, but to rule out a different medical condition. For example, some different medical issues like viruses, diseases or thyroid problems may cause a depressed mood, changes in weight or other signs of depression.
The Hamilton Scale is one of the oldest forms of scaling depression severity and major depression. However, it was originally developed to assess how severe depression is in patients that are already diagnosed and on antidepressants.
While that’s the case, it’s also used to diagnose depression sometimes.
However, compared to other scaling systems, Hamilton shows more variability in results upon retesting, so many professionals choose to use a different scale.
The Montgomery-Asberg Depression Scale (MADRS) was conceived as a response to the Hamilton Scale and is considered by many professionals to be an improvement in the diagnoses of major depression.
The MADRS measures responses using categories and common symptoms like sadness, negative thoughts, detachment and change in appetite to measure severity.
It has been shown in studies to be an effective way to diagnose depression and its severity and symptom changes based on medication for men and women.
The Beck Scale is another common scale similar to MADRS. Beck is a self-reporting tool to assess symptoms of depression. It includes 21 statements and takes about 10 minutes to complete.
The Beck Scale has been shown in studies to be comparable to the MADRS for effectiveness.
After you’re diagnosed with depression, you’ll learn what type of depression you have and work with a healthcare provider to assess the best treatment for your specific situation.
It’s incredibly important to treat depressive episodes and find long-term treatment for your issues as quickly as possible.
Once diagnosed with a certain type of depression, your healthcare provider will likely refer you to a mental health professional like a psychologist or psychiatrist to determine a treatment plan.
Far as depression types go, here are some of the more common ones:
Clinical depression is when you show symptoms of depression for more than two weeks and it impacts your daily life and routine.
Persistent depressive disorder is long episode of depression, lasting for more than two years. In this case, your symptoms may fluctuate from more severe to less severe. However, they are consistently present for at least two years.
This is depression onset by changing seasons. While SAD is most common in the winter months for most people, it can happen during any season.
Those with seasonal affective disorder experience symptoms of depression at around the same time every year, but generally experience relief of symptoms as the season changes.
Bipolar disorder is not depression. However, it can sometimes be confused with depression because when a person with bipolar experiences lows, they show similar symptoms to someone with depression.
Treatment of depression will depend on the individual, diagnosis, severity and the best plan of action decided by a provider. However, standard treatment plans for depression include medication, therapy or a combination of both.
Antidepressants are the most common medications for depression. Common antidepressants include sertraline, paroxetine, fluoxetine, citalopram and others in the selective serotonin reuptake inhibitors (SSRI) family.
Psychotherapy is another common treatment option. Two specific therapies shown to be impactful for depressive symptoms are cognitive behavioral therapy and interpersonal therapy.
Cognitive-behavioral therapy focuses on behaviors and thoughts and challenges you to observe and think about these patterns in order to change them.
Interpersonal therapy focuses on observing mood, personal events and support structures, and how the three interact. This type of therapy hopes to teach how to deal with life events by setting certain expectations, developing support structures and understanding depression.
You may also want to consider depression counseling.
There are other treatment options — however, most are not approved by the Food and Drug Administration (FDA) for the treatment of depression, nor are they proven to be as effective as medication and therapy.
Some common alternative treatments include St. John’s wort, Omega-3 fatty acid supplement, acupuncture, mindfulness and yoga.
While the research on many of these alternatives is promising, it’s worth the reminder: much more is needed before we say anything definitively about their efficacy.
Getting a proper diagnosis of depression is the first step to getting help and improving symptoms of depression.
To be diagnosed with depression, a healthcare professional will first run other tests to rule out other causes and then take a look at symptoms and severity. Mental health professionals may use depression scales to diagnose the severity or test how the treatment is going.
There are multiple effective treatments for those with depression. Specific treatment plans will depend on the person and what they determine is best with the help of a mental health professional.
If you are concerned about your own symptoms of depression, contact your healthcare provider and get the help you need.