health

The diagnosis of depression is complicated and often missed, particularly
in the elderly. Diagnosis begins with a complete physical examination,
partly to see whether the patient has medical problems that may increase
his or her risk of depression, and partly to rule out physical reasons for
changes in mood. These include thyroid disorders, infectious diseases like
syphilis or Lyme disease, and prescription medications that are known to
affect mood. The doctor may order blood or urine tests as part of the
physical examination.
Another important part of the diagnosis is taking the patient’s personal
and family history. This part of the patient interview often includes
giving the patient the Beck Depression Inventory or another questionnaire
that can be completed in the doctor’s office in a few minutes. There
are special questionnaires of this sort for children and adolescents.
The doctor will also listen to the way the patient talks as well as the
content of what they are saying, because depressed people often talk
slowly and may sound sad. The patient’s facial expressions and the way
they are dressed may also provide clues; a patient who is usually neat and
tidy may come to the office looking poorly groomed.
Primary care doctors will usually refer their patients to psychiatrists
(mental health specialists) in order to distinguish major depression from
other mental illnesses, and to prescribe treatments for the depression.