How is depression diagnosed?

To effectively diagnose and treat depression, the doctor must hear about specific signs and symptoms of depression. While a physical examination will reveal a patient's overall state of health, by talking with a patient, a doctor can learn about other things that are relevant to making a depression diagnosis. A patient, for example, can report on such things as daily moods, behaviors, and lifestyle habits.
A depression diagnosis is often difficult to make because clinical depression can manifest in so many different ways. For example, some clinically depressed individuals seem to withdraw into a state of apathy. Others may become irritable or even agitated. Eating and sleeping patterns can be exaggerated. A depressed person may either sleep or eat to excess or almost eliminate those activities.
Observable or behavioral symptoms of clinical depression may be minimal despite a person experiencing profound inner turmoil. Depression is a pernicious and all-encompassing disorder, and it affects a person's body, feelings, thoughts, and behaviors in varying ways.

What does the doctor look for to make a depression diagnosis?

A doctor can rule out other conditions that may cause depression with a physical examination, personal interview, and lab tests. The doctor will also conduct a complete diagnostic evaluation, discussing any family history of depression. Your doctor will evaluate your symptoms, including how long you've had them, when they started, and how they were treated.

How can depression symptoms lead to a depression diagnosis?

Depression symptoms can last for months or years. They can cause significant personality changes and changes in work habits, making it difficult for others to have empathy for you. Some symptoms are so disabling that they interfere significantly with your ability to function. In very severe cases, people with depression may be unable to eat or even to get out of bed.

Symptomatic episodes may occur only once in a lifetime or may be recurrent, chronic, or longstanding. In some cases, they seem to last forever. Occasionally, symptoms appear to be precipitated by life crises or other illnesses. At other times, they occur at random.

Clinical depression commonly occurs along with other medical illnesses such as heart disease or cancer and worsens the prognosis for these illnesses.

Are there physical signs of depression?

Physical signs of depression may include the following:
•    appearance of preoccupation
•    lack of eye contact
•    memory loss, poor concentration, and poor abstract reasoning
•    pacing, hand wringing, and pulling on hair
•    psychomotor retardation or agitation, such as slowed speech, sighs, and long pauses
•    self-deprecatory manner, or belligerence and defiance (especially in adolescents)
•    slowed body movements, even to the extent of being motionlessness or catatonia
•    tearfulness or sad countenance

What does the doctor look for in the physical exam that helps to diagnose depression?

When performing the physical examination, the doctor may focus primarily on the nervous and hormonal systems. The doctor will try to identify any major health concerns that may be contributing to symptoms of clinical depression. For example, hypothyroidism -- caused by an underactive thyroid gland -- is the most common medical condition associated with depressive symptoms. Other hormone disorders associated with depression include hyperthyroidism -- caused by an overactive thyroid -- and Cushing's disease -- a disorder of the adrenal gland.

What lab tests will my doctor do while checking for depression?

Your doctor can usually tell if you have depression by doing a physical exam and asking you specific questions. Your doctor may, however, ask for lab tests to rule out other diagnoses. Your doctor will likely do blood tests to check for medical conditions that may cause depressive symptoms. He or she will use the blood tests to check for such things as anemia, thyroid and hormone levels, and calcium levels.

Are there other lab tests the doctor will want before diagnosing depression?

The doctor may include other standard tests as part of the initial physical exam. Among them may be blood tests to check electrolytes, liver function, and kidney function. Because the kidneys and liver are responsible for the elimination of depression medications, impairment to either of these two organs may cause the drugs to accumulate in the body.
Other tests may include:

•    CT scan or MRI of the brain to rule out serious illnesses such as a brain tumor
•    electrocardiogram (ECG), which is used to diagnose an arrhythmia, particularly heart block
•    electroencephalogram (EEG), which uses an apparatus for recording electrical activity from the brain

Corticosteroid medications such as prednisone, which people take for diseases such as rheumatoid arthritis or asthma, are also associated with depression. Other drugs, including illegal steroids and amphetamines and over-the-counter appetite suppressants, may cause depression on withdrawal.

What lab tests will my doctor do while checking for depression?

Your doctor can usually tell if you have depression by doing a physical exam and asking you specific questions. Your doctor may, however, ask for lab tests to rule out other diagnoses. Your doctor will likely do blood tests to check for medical conditions that may cause depressive symptoms. He or she will use the blood tests to check for such things as anemia, thyroid and hormone levels, and calcium levels.

Will the doctor look at my brain before diagnosing depression?

Looking at how the brain functions has not been standard in diagnosing depression, but it can yield very important information on diagnosing and treating psychological problems.  The good news is that looking at the brain is becoming more widespread—especially with treatment resistant depression.
•    Functional brain images such as SPECT or PET scans to assess brain activity and see if there are areas of abnormal functioning.
•    CT scan or MRI of the brain to rule out serious illnesses such as a brain tumor
•    electroencephalogram (EEG), which uses an apparatus for recording electrical activity from the brain
Psychotherapy for Depression
Psychological counseling has been shown to be just as effective as antidepressant medication in treating many people with depression.  There are many different types of counseling which we will look at here.

What can psychotherapy do to help with clinical depression?

The role of psychotherapy in treating clinical depression is to help the person develop appropriate and workable coping strategies for dealing with everyday stressors. In addition, it can help you use your medications properly.

Many studies support the idea that therapy can be a powerful treatment for depression. Some have also found that combining depression medicine with therapy can be particularly effective. A 2004 review published in the Archives of General Psychiatry, for example, concluded that therapy combined with antidepressants worked better than depression medicine alone. It also supported the idea that therapy can help people stay compliant with their drug treatment in the long term.

What are the benefits of psychotherapy with depression?

There are a number of benefits to be gained from using psychotherapy in treating clinical depression:
•    It can help reduce stress in your life.
•    It can give you a new perspective on problems with family, friends, or co-workers.
•    It can make it easier to stick to your treatment.
•    You can use it to learn how to cope with side effects from depression medication.
•    You learn ways to talk to other people about your condition.
•    It helps catch early signs that your depression is getting worse.

What are the different types of psychotherapy?

There are many different types of therapy. Here are some of the most common.
Cognitive therapy, behavioral therapy, and cognitive behavioral therapy all focus on how your own thoughts and behaviors contribute to your depression. Your therapist will help you learn new ways to react to situations and challenge your preconceptions. You and your therapist might come up with concrete goals. You might also get 'homework' assignments, like keeping a journal or applying problem-solving techniques in particular situations.

Interpersonal therapy focuses on how your relationships with other people play a role in your depression. It focuses on practical issues. You will learn how to recognize unhealthy behaviors and change them.
Psychodynamic therapy is a more traditional form of therapy. You and your therapist will explore the roots of your depression. You might focus especially on any traumas of your childhood.
Individual counseling is a one-on-one session with a professional therapist with experience in depression and other mood disorders. In those sessions, you will address individual problem areas. The session may include specific help with acceptance of the diagnosis, education about depression, ways to identify the warning signs, and intervention strategies to manage stress and other depression triggers so you can avoid a major episode.

Because life’s stressors can exacerbate a depressive mood episode, one-to-one sessions can help the person with depression identify stressors as well as increase coping skills and overall resilience. Adequate sleep is especially important in depressive illnesses since poor sleep can precipitate a depressive episode. Working with a therapist, patients can learn to identify barriers to getting the sleep they need. They can also develop healthy patterns of activity and social involvement, thereby influencing their overall quality of life.

Additionally, when needed, therapeutic sessions can focus on compliance with regular office appointments, taking prescribed doses of medications, and obtaining blood medication levels.
Family counseling treats the entire family because depression extends far beyond the patient. Family members often have to cope with the patient's low moods during the depression. While family members may have the best of intentions, without professional guidance, they sometimes make things worse.

Families are frequently involved in outpatient therapy as they become educated about the various signs and symptoms of depression and work with the therapist and patient to learn how to recognize early warnings of an impending episode. Recent findings suggest that these sessions may be valuable treatment components, adding significant benefit to medication compliance and lifestyle and sleep management.
Family meetings are also beneficial for helping everyone deal with the stress of an emotional illness. They also allow the patient and family members to openly discuss grievances without placing blame.
Group counseling sessions allow for the sharing of feelings and the development of effective coping strategies. The give-and-take at group sessions is often the most productive way to change the way you think about your illness and improve your ability to cope with life’s challenges and difficulties.
What is maintenance therapy for depression?

While some people only need therapy for short periods of time, people with treatment-resistant depression might need it for longer. This is called maintenance therapy. Studies show that maintenance therapy lowers your risk of relapse. You and your therapist can watch for signs that your depression might be worsening. Over time, you will also learn about the patterns in your life that lead to depression.

Antidepressant Medication

Antidepressants work by helping to rebalance brain chemicals called neurotransmitters.  The main three neurotransmitters involved in depression are serotonin, dopamine, and norepinephrine.  Your doctor can evaluate if you need antidepressant medication and which one would be the best choice for you.  Antidepressants are usually effective in reducing or eliminating depression in about 2 out of every 3 people.  Combining antidepressants with psychotherapy, exercise, supplements, and the proper diet increases their effectiveness.


There are several types of antidepressant medications used to treat depressive disorders. These include newer medications--chiefly the selective serotonin reuptake  inhibitors (SSRIs)--the tricyclics, and the monoamine oxidase inhibitors (MAOIs). The SSRIs--and other newer medications generally have fewer side effects than tricyclics. Antidepressant medications must be taken regularly for as many as 8 weeks before the full therapeutic effect occurs.

Patients often are tempted to stop medication too soon. They may feel better and think they no longer need the medication. Or they may think the medication isn't helping at all. It is important to keep taking medication until it has a chance to work, though side effects may appear before antidepressant activity does. Once the individual is feeling better, it is important to continue the medication for 4 to 6 months to prevent a recurrence of the depression. Some medications must be stopped gradually to give the body time to adjust.

Antidepressant drugs are not habit-forming. However, as is the case with any type of medication prescribed for more than a few days, antidepressants have to be carefully monitored to see if the correct dosage is being given. The doctor will check the dosage and its effectiveness regularly.

For the small number of people for whom MAO inhibitors are the best treatment, it is necessary to avoid certain foods that contain high levels of tyramine, such as many cheeses, wines, and pickles, as well as medications such as decongestants. The interaction of tyramine with MAOIs can bring on a hypertensive crisis, a sharp increase in blood pressure that can lead to a stroke. The doctor should furnish a complete list of prohibited foods that the patient should carry at all times. Other forms of antidepressants require no food restrictions.


What is the transcranial magnetic stimulation (TMS) device for treating depression?

The FDA has cleared the NeuroStar TMS device for treating depressed adults for whom one antidepressant has failed to work.  TMS creates a magnetic field to induce a much smaller electric current in a specific part of the brain without causing seizure or loss of consciousness.  TMS is used to treat milder depression and works best in patients who have failed to benefit from one, but not two or more, antidepressant treatments.  TMS does not require sedation and is administered on an outpatient basis.  Patients undergoing TMS must be treated four or five times a week for four weeks.

Supplements

What is a natural dietary supplement?

Dietary supplements include vitamins, minerals, herbs, and amino acids. They come in the form of pills, liquids, or powders and people add them to their diets to gain health benefits they believe they are missing otherwise.

St. John's Wort for Treating Depresion
Is it possible to use St. John's wort, an herbal  remedy, to treat depression? Millions of people around the world actually do. They see St. John's wort as an alternative or natural treatment for depression.

What is St. John's wort?

St. John's wort is a wild yellow flower that has been used for medical purposes in other parts of the world for thousands of years.  
Is there scientific evidence that supports the use of St. John's wort for depression? More than 30 clinical studies have been conducted over the past 22 years to evaluate the effectiveness of St. John's wort.  There is some scientific evidence that St. John's wort is helpful in treating mild to moderate depression.

Diet for Depression

Trying to find a diet to ease depression? While certain diets or foods may not ease depression (or put you instantly in a better mood), they may help as part of an overall treatment for depression. There's more and more research indicating that, in some ways, food and mood are connected.

How can my diet affect my depression?

Dietary changes can bring about changes in your brain structure, both chemically and physiologically. Those changes can improve mood and mental outlook. Here are 10 tips for eating if you or a loved one is recovering from clinical depression.

1. Eat a diet high in nutrients
Nutrients in foods support the body's repair, growth, and wellness. Nutrients we all need include vitamins, minerals, carbohydrate, protein, and even a small amount of fat. A deficiency in any of these nutrients lead to our bodies not working at full capacity – and can even cause illness.

2. Fill your plate with essential antioxidants
Damaging molecules called free radicals are produced in our bodies during normal body functions – and these free radicals contribute to aging and dysfunction. Antioxidants such as beta-carotene and vitamins C and E combat the effects of free radicals. Antioxidants have been shown to tie up these free radicals and take away their destructive power.
Studies show that the brain is particularly at risk for free radical damage. Although there’s no way to stop free radicals completely, we can reduce their destructive effect on the body by eating foods high in powerful antioxidants, including:
•    Sources of beta-carotene: apricots, broccoli, cantaloupe, carrots, collards, peaches, pumpkin, spinach, sweet potato. 
•    Sources of vitamin C: blueberries, broccoli, grapefruit, kiwi, oranges, peppers, potatoes, strawberries, tomato. 
•    Sources of vitamin E: margarine, nuts and seeds, vegetable oils, wheat germ.

3. Eat “smart” carbs for a calming effect
The connection between carbohydrates and mood is linked to the mood-boosting brain chemical, serotonin. We know that eating persuasive foods high in carbohydrates (breads, cereal, pasta) raises the level of serotonin in the brain. When serotonin levels rise, we feel a calming effect with less anxiety.
So don’t shun carbs – just make smart choices. Limit sugary foods and opt for smart carbs, such as whole grains, fruits, vegetables, and legumes, which all contribute healthy carbs as well as fiber.

4. Eat protein rich foods to boost alertness
Foods rich in protein, like turkey, tuna, or chicken, are rich in an amino acid called tyrosine. Tyrosine boosts levels of the brain chemicals dopamine and norepinephrine. This boost helps you feel alert and makes it easier to concentrate. Try to include a protein source in your diet several times a day, especially when you need to clear your mind and boost your energy.
•    Good sources of protein foods that boost alertness: beans and peas, lean beef, low-fat cheese, fish, milk, poultry, soy products, yogurt.

5. Eat a Mediterranean type diet
The Mediterranean diet is a balanced, healthy eating pattern that includes plenty of fruits, nuts, vegetables, cereals, legumes, and fish. All of these are important sources of nutrients linked to preventing depression.
A recent Spanish study, using data from 4,211 men and 5,459 women, found that rates of depression tended to increase in men -- especially smokers -- as folate intake decreased. The same increase occurred for women -- especially those who smoked or were physically active -- but with a decreased intake of another B-vitamin: B12. This wasn't the first study to discover an association between these two vitamins and depression. Researchers wonder whether poor nutrient intake leads to depression or whether depression leads people to eat a poor diet.
Folate is found in Mediterranean diet staples like legumes, nuts, many fruits, and particularly dark green vegetables. B12 can be found in all lean and low-fat animal products, such as fish and low-fat dairy products.

 6. Get plenty of vitamin D
Vitamin D increases levels of serotonin in the brain. Researchers, though, are unsure how much vitamin D is ideal. There are individual differences based on where you live, the time of year, your skin type, and your level of sun exposure. Researchers from the University of Toronto noticed that people who were suffering from depression, particularly those with seasonal affective disorder, tended to improve as their levels of vitamin D in the body increased over the normal course of a year. The recommendation is to try to get about 600 international units (IU) of vitamin D a day from food if possible.

7. Select selenium-rich foods
Selenium is a mineral that is essential to good health. In a small study from Texas Tech University, supplementation of 200 micrograms a day for seven weeks improved mild and moderate depression in 16 elderly participants. Other studies have also reported an association between low selenium intakes and poorer moods.
It is possible to take in too much selenium so that it becomes toxic. But this is unlikely if you're getting it from foods rather than supplements, and it can't hurt to make sure you're eating foods that help you meet the recommended intake for selenium, which is 55 micrograms a day. The good news is that foods rich in selenium are foods we should be eating anyway. They include:
•    Beans and legumes
•    Lean meat (lean pork and beef, skinless chicken and turkey)
•    Low-fat dairy products
•    Nuts and seeds (particularly brazil nuts)
•    Seafood (oysters, clams, sardines, crab, saltwater fish, and freshwater fish)
•    Whole grains (whole-grain pasta, brown rice, oatmeal, etc.)

 8. Include omega-3 fatty acids in your diet
We know that omega-3 fatty acids have innumerable health benefits. Recently, scientists have revealed that a deficit of omega-3 fatty acids is associated with depression. In one study, researchers determined that societies that eat a small amount of omega-3 fatty acids have a higher prevalence of major depressive disorder than societies that get ample omega-3 fatty acids. Other epidemiological studies show that people who infrequently eat fish, which is a rich source of omega-3 fatty acids, are more likely to suffer from depression.
•    Sources of omega-3 fatty acids: fatty fish (anchovy, mackerel, salmon, sardines, shad, and tuna), flaxseed, and nuts.
•    Sources alpha-linolenic acid (another type of omega-3 fatty acid): flaxseed, canola oil, soybean oil, walnuts, and dark green leafy vegetables.

9 Watch your lifestyle habits
Many people who are depressed also have problems with alcohol and/or drugs. Not only can alcohol and drugs interfere with mood, sleep, and motivation, they can also affect the effectiveness of your depression medications. In addition, drinks and foods containing caffeine can trigger anxiety and make it difficult to sleep at night. Cutting out caffeine or stopping caffeine after noon each day can also help
you get a better night's sleep.

10. Stay at a healthy weight
Findings published in the journal of Clinical Psychology: Science and Practice, show a link between obesity and depression, indicating that people who are obese may be more likely to become depressed. In addition, according to this study, people who are depressed are more likely to become obese. Researchers believe the link between obesity and depression may result from physiological changes that occur in the immune system and hormones with depression. If you have a weight problem, talk with your doctor about healthy ways to manage it with diet and exercise.

Exercise and Depression

Many studies indicate that people who exercise regularly benefit with a positive boost in mood and lower rates of depression.
What are the psychological benefits of exercise with depression?
Improved self-esteem is a key psychological benefit of regular physical activity. When you exercise, your body releases chemicals called endorphins. These endorphins interact with the receptors in your brain that reduce your perception of pain.
Endorphins also trigger a positive feeling in the body, similar to that of morphine. For example, the feeling that follows a run or workout is often described as "euphoric." That feeling, known as a "runner's high," can be accompanied by a positive and energizing outlook on life.
Endorphins act as analgesics, which means they diminish the perception of pain. They also act as sedatives. They are manufactured in your brain, spinal cord, and many other parts of your body and are released in response to brain chemicals called neurotransmitters. The neuron receptors endorphins bind to are the same ones that bind some pain medicines. However, unlike with morphine, the activation of these receptors by the body's endorphins does not lead to addiction or dependence.

Regular exercise has been proven to help:
•    Reduce stress
•    Ward off anxiety and feelings of depression
•    Boost self-esteem
•    Improve sleep

Exercise also has these added health benefits:
•    It strengthens your heart.
•    It increases energy levels.
•    It lowers blood pressure.
•    It improves muscle tone and strength.
•    It strengthens and builds bones.
•    It helps reduce body fat.
•    It makes you look fit and healthy.

Is exercise a treatment for clinical depression?

Research has shown that exercise is an effective but often underused treatment for mild to moderate depression.

Do particular types of exercise help depression?

It appears that any form of exercise can help depression. Some examples of moderate exercise include:
•    Biking
•    Dancing
•    Housework, especially sweeping, mopping, or vacuuming
•    Jogging at a moderate pace
•    Low-impact aerobics
•    Playing tennis
•    Swimming
•    Walking
•    Yoga

Because strong social support is important for those with depression, joining a group exercise class may be beneficial. Or you can exercise with a close friend or your partner. In doing so, you will benefit from the physical activity and emotional comfort, knowing that others are supportive of you.

How often should I exercise to ease depression?

Studies indicate that exercising at least 30 minutes a day four or five times a week is best. Take it easy if you are just beginning. Start exercising for 20 minutes. Then you can build up to 30 minutes.

How do I get started exercising to help depression?

Here are some tips to help you get started:
•    Choose an activity you enjoy. Exercising should be fun.
•    Put your exercise routine into your schedule. If you need reminding, put it on your calendar.
•    Variety is the spice of life. Make sure you vary your exercises so that you don't get bored. Check your local gymnasium or community center for an assortment of exercise programs.
•    Don't let exercise programs break the bank. Unless you are going to be using them regularly, avoid buying health club memberships or expensive equipment.
•    Stick with it. If you exercise regularly, it will soon become part of your lifestyle and will help reduce your depression.

What if I can’t exercise?

If you are unable to regularly participate in exercise or athletics, you can also try other tools to help boost your mood. Studies of meditation and massage therapy have demonstrated that these techniques can stimulate endorphin secretion, increase relaxation, and aid in boosting mood.