Understanding Depression: Diagnosis and Treatment

The first step in treating depression is recognition. However, depression can be difficult to diagnose because it often is masked by or mistaken for other chronic diseases such as diabetes or heart disease.

But depression should be viewed as a separate, treatable clinical condition that has a ripple effect on other chronic medical conditions.

If you think you may be depressed, make an appointment to talk with your primary care doctor or a behavioral health specialist, such as a psychiatrist, psychologist or social worker.

They may use a standardized tool or set of questions to assess you for depression. Many follow guidelines provided by the Michigan Quality Improvement Consortium (MQIC) which evaluate common symptoms including:

  1. Depressed mood
  2. Marked diminished interest/pleasure
  3. Significant weight gain/loss, appetite decrease/increase
  4. Insomnia/hypersomnia
  5. Psychomotor agitation/retardation noticeable by others
  6. Fatigue/loss of energy
  7. Feelings of worthlessness or inappropriate guilt
  8. Diminished concentration or indecisiveness
  9. Recurrent thoughts of death or suicidal ideation
  10. Hopelessness

Once an evaluation is complete, treatment of depression may include:

  • Stopping medication causing depressive side effects
  • Psychotherapy or behavioral therapy
  • A “prescription” for exercise and increased social interaction
  • Antidepressant medication that is monitored frequently and adjusted as needed

If an antidepressant is prescribed, a doctor should monitor the response to the medication frequently (e.g., every two weeks), and adjust as needed. Keep the following in mind:

  • Don’t abruptly discontinue medication. Working closely with your doctor, you may decide to reduce dosage gradually over several weeks.
  • Recurrent major depression usually requires lifelong treatment.
  • Continue medication for at least nine to 12 months after acute symptoms resolve.

Patients who are referred for evidence-based psychotherapy or behavioral therapy should keep the following in mind:

  • You and your behavioral health specialist should regularly monitor and assess your treatment plan, goals and progress.
  • Maintain ongoing communication with your behavioral health specialist.
  • Recurrent major depression usually requires lifelong treatment.

Mary Beth BoltonDr. Mary Beth Bolton is medical director of PPO and Care Management for Blue Cross Blue Shield of Michigan. She’s also board certified in internal medicine.

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Photo credit: Bodie Strain

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