doctors

The most common diagnostic tool used by doctors to help them decide if a patient with symptoms of depression is actually suffering from the full on illness (and not just a passing state of feeling sad that’s caused by a life event) is a questionnaire.

How do doctors diagnose depression? Here are the common tests they use:

Currently the most common ones are:

Hamilton Depression Rating Scale (HAMD)
Montgomery-Asberg Depression Rating Scale (MADRS)
Beck Depression Inventory
Patient Health Questionnaire (PHQ-9)

Your doctor will likely used one of these tests to assess you. Questions are similar in nature for each. They ask you about symptoms your experiencing – such as: Sleep disturbances, issues with fatigue, suicidal thoughts, feeling uninspired or hopeless, loss of motivation, loss of pleasure. They will also ask you questions to help them understand the severity of your symptoms.

Here are some examples of the types of questions you may be asked:

Have you lost interest in activities you used to find pleasurable?
Ae you experiencing changes in appetite such as eating too much or not feeling like you want to eat?
Are you having difficulty concentrating?
Having you been experiencing thoughts of suicide, death, or wanting to die?

In most cases, if you have felt hopeless for a least two weeks or more and it’s so bad it’s affecting your life – you’re having trouble going to work, socializing, enjoying activities you once thought were pleasurable etc. – these are high indications you have depression.

The diagnostic criteria for depression appears in a medical text for mental illness called the DSM-IV. (Read the diagnostic criteria here).

Your doctor will also likely run some basic biological tests to rule out other potential issues that cause depression. The most common ones are the:

Physical exam. Your doctor will likely examine your body to ensure there is nothing notable wrong with your physiology that could be causing depression symptoms.
Blood tests : A blood sample may be taken and a complete blood count (CBC) will be performed. This helps the doctor find out if you have any hormonal issues or a vitamin deficiency.

How doctors “fix depression”: Antidepressants

If your doctor rules out all other medical issues that could be causing your depressed mood and suggests a diagnosis of major depression they’ll likely treat you by prescribing an antidepressant medication. Doctors are trained to fix medical problems and this is how they do cure depression. It’s the only tool available to them, aside from referring you to a different type of specialist.

You need to be aware that the problem with this route is that they may skip identifying other potential causes for your depression. They will treat the symptoms without curing them. So, you need to investigate therapeutic forms of treatment that teach you how to proactively deal with negative and uncomfortable emotions.

What you need to understand about antidepressant medications:

Finding the right antidepressant for you is like finding the perfect wedding dress. You have to “try on” many to find what works for you. This is because the current diagnostic criteria that doctors use is based on asking you a line of questions, ruling out other illnesses with basic physical tests, and then making an educated assumption.

They don’t do a brain scan to see what’s really going on and here’s why:

It would put too much pressure on the medical system to do these tests for the number of people who end up in their office with symptoms of depression. There are too many people that treating everyone would cause a dramatic back up. This would lead to longer treatment wait times, and possibly more deaths. So, prescribing an antidepressant is the fastest way to treat depression.
Even if they could see what brain regions were affected it still wouldn’t tell them anything about how the condition was caused and thus what treatment to use. So, brain scans would help to identify the problem but hast nothing to do with treating it. Therefore, it’s a lot of fuss for no reason.

So, they test you on a medication for 4-6 weeks and if it doesn’t work, they try something else. If you get worse, well, the sad truth is, sometimes that’s part of the process.

As you can see, this is hardly an effective treatment. But for now, it’s all doctors have. A questionnaire, some basic tests and a lot of trial and error with antidepressants.

But, don’t blame the doctor, it’s the system that’s flawed. We don’t know enough. And because we don’t know our treatment options are unfortunately somewhat limited right now. That is why it’s important to do what you can to help speed up your recovery process.

Finding the right anti-depressant medication requires a trial and error approach. Currently, there exists no test to accurately measure your symptoms. So your doctor doesn’t really know what to prescribe you. They select one from a list, prescribe it to you and monitor you over 4-12 weeks (this is how long it takes to see benefits and qualify a medication) to see if what they’ve chosen works. If not, they try another medication. This process continues until they find what works.

How doctors prescribe antidepressants:

There are approximately 22 antidepressant medications on the market that have been approved by the American Federal Drug Association (FDA). They fall under four categories, labeled for the brain chemical they target. (each variety is explained below) In order to choose an appropriate medication for you, your doctor may consider these factors:

Your situation. Each case of depression is different, which means so are the symptoms. Your doctor will like assess your situation and choose an antidepressant that is likely not amplify a negative issue you are dealing with. For example, if you are severely overweight or have an eating disorder a doctor will try and prescribe a medication that does not have a side effects of weight gain because that will only make your situation worse.
Your lifestyle. Antidepressants have side effects that can unobstrusive but annoying (ie. dry mouth, low sex drive). A doctor may ask you some lifestyle questions to help him discover what a good medication would be. For example, if you are a man trying to have a baby with your wife, taking a low sex drive medication may not be helpful.
Your current physiology. Your doctor will evaluate your current physiology, this includes taking into account other health conditions you may have. If you are pregnant or breast feeding, there are some antidepressants you should not take.
Your genetics. If you have a family members that takes antidepressants your doctor may prescribe the same treatment. Often genes play a role in how a patient reacts to a medication. If it work for a family member with a similar genetic predisposition then it may be effective for you.
Your finance capabilities. If you do not have medical coverage antidepressants can cost up to $350/month. Some antidepressants are cheaper than others.
Your other medications. Are you taking other supplements and/or medications? This will be considered as some medications work negatively together.

How do anti-depressants work?:

The basic premise of an antidepressant is that once you take it the drug passes through your body via your blood and into your brain. There, it targets a specific brain chemical (or chemicals) that control your mood.

If you read the word “inhibitor reuptake” what that means is that the drugs stops a process where the chemical does not re-enter the brain cell, which it would normally do. That means, less of the chemical remains in the nerve cell.

The brain chemicals that are targeted by these drugs are called: Dopamine, Serotonin, and Norepinephrine

Selective serotonin re-uptake inhibitors (SSRIs)

These medications are safer and generally cause fewer bothersome side effects than other types of antidepressants.

Common SSRIs by drug name include: Prozac, Selfemra, Paxil, Pexeva, Zoloft, Celexa, Lexapro

Serotonin and norepinephrine re-uptake inhibitors (SNRIs)

Common SNRIs by drug name include: Cymbalta, Effexor XR, Pristiq, Khedezl, Fetzima

Norepinephrine and dopamine re-uptake inhibitors (NDRIs)

One of the few antidepressants not frequently associated with sexual side effects.

Common NDRIs by drug name include: Wellbutrin, Aplenzin, Forfivo XL.

Tricyclics

Not many doctors prescribe tricyclics these days, though they are still effective for many people. They are often used after other drugs haven’t work. They’ve been replaced because they tend to have more side effects.

Cyclic antidepressants block the absorption (reuptake) of the neurotransmitters serotonin (ser-o-TOE-nin) and norepinephrine (nor-ep-ih-NEF-rin), making more of these chemicals available in the brain. This seems to help brain cells send and receive messages, which in turn boosts mood.

Norpramin, Tofranil, Pamelor, Vivactil, Trimipramine, Surmontil

MAOIs Using an MAOI requires a strict diet because of dangerous food interactions. Selegiline (Emsam), a newer MAOI that you stick on your skin as a patch, may cause fewer side effects than other MAOIs

Atypical antidepressants

Oleptro, Remeron, Brintellix, Viibryd

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