How Depression Is Diagnosed

Depression: Types, Symptoms, Causes & Treatment

How Depression Is Diagnosed

Depression is a medical condition that affects your mood and ability to function.

Depression types include clinical depression, bipolar depression, dysthymia, seasonal affective disorder and others.

Treatment options range from counseling to medications to brain stimulation and complementary therapies. Depression

Depression is a medical condition that affects your mood and ability to function.

Depressive symptoms include feeling sad, anxious or hopeless. The condition can also cause difficulty with thinking, memory, eating and sleeping.

A diagnosis of major depressive disorder (clinical depression) means you have felt sad, low or worthless most days for at least two weeks while also having other symptoms such as sleep problems, loss of interest in activities, or change in appetite.

Without treatment, depression can get worse and last longer. In severe cases, it can lead to self-harm or death. Fortunately, treatments can be very effective in improving symptoms of depression.

How common is depression?

Depression is common all over the world. Healthcare providers estimate that nearly 7% of American adults have depression every year. More than 16% of U.S. adults — around 1 in 6 — will experience depression in their lifetime.

What are the types of depression?

Healthcare providers name depression types according to symptoms and causes. These episodes often have no obvious cause. In some people, they can linger much longer than in others for no clear reason.

Types of depression include:

  • Major depressive disorder (MDD): Major depression (clinical depression) has intense or overwhelming symptoms that last longer than two weeks. These symptoms interfere with everyday life.
  • Bipolar depression: People with bipolar disorder have alternating periods of low mood and extremely high-energy (manic) periods. During the low period, they may have depression symptoms such as feeling sad or hopeless or lacking energy.
  • Perinatal and postpartum depression: “Perinatal” means around birth. Many people refer to this type as postpartum depression. Perinatal depression can occur during pregnancy and up to one year after having a baby. Symptoms go beyond “the baby blues,” which causes minor sadness, worry or stress.
  • Persistent depressive disorder (PDD): PDD is also known as dysthymia. Symptoms of PDD are less severe than major depression. But people experience PDD symptoms for two years or longer.
  • Premenstrual dysphoric disorder (PMDD): Premenstrual dysphoric disorder is a severe form of premenstrual disorder (PMS). It affects women in the days or weeks leading up to their menstrual period.
  • Psychotic depression: People with psychotic depression have severe depressive symptoms and delusions or hallucinations. Delusions are beliefs in things that are not based in reality, while hallucinations involve seeing, hearing, or feeling touched by things that aren’t actually there.
  • Seasonal affective disorder (SAD): Seasonal depression, or seasonal affective disorder, usually starts in late fall and early winter. It often goes away during the spring and summer.

Various factors can cause depression:

  • Brain chemistry: Abnormalities in brain chemical levels may lead to depression.
  • Genetics: If you have a relative with depression, you may be more ly to become depressed.
  • Life events: Stress, the death of a loved one, upsetting events (trauma), isolation and lack of support can cause depression.
  • Medical conditions: Ongoing physical pain and illnesses can cause depression. People often have depression along with conditions diabetes, cancer and Parkinson’s disease.
  • Medication: Some medications have depression as a side effect. Recreational drugs and alcohol can also cause depression or make it worse.
  • Personality: People who are easily overwhelmed or have trouble coping may be prone to depression.

What are the symptoms of depression?

Depression can affect your emotions, mind and body. Depression symptoms include:

  • Feeling very sad, hopeless or worried.
  • Not enjoying things that used to give you joy.
  • Being easily irritated or frustrated.
  • Eating too much or too little.
  • Changes in how much you sleep.
  • Having a difficult time concentrating or remembering things.
  • Experiencing physical problems headache, stomachache or sexual dysfunction.
  • Thinking about hurting or killing yourself.

If you or someone you know has thoughts of hurting themselves, please call the National Suicide Prevention Lifeline at 800.273.8255. This national network of local crisis centers provides free, private emotional support to people in suicidal crisis or emotional distress 24 hours a day, seven days a week.

Everyone may feel sad or down from time to time. However, clinical depression has more intense symptoms that last two weeks or longer.

To determine whether you have clinical depression, your healthcare provider will ask questions. You may complete a questionnaire and provide a family history. Your healthcare provider may also perform an exam or order lab tests to see if you have another medical condition.

Depression can be serious, but it’s also treatable. Treatment for depression includes:

  • Self-help: Regular exercise, getting enough sleep, and spending time with people you care about can improve depression symptoms.
  • Counseling: Counseling or psychotherapy is talking with a mental health professional. Your counselor helps you address your problems and develop coping skills. Sometimes brief therapy is all you need. Other people continue therapy longer.
  • Alternative medicine: People with mild depression or ongoing symptoms can improve their well-being with complementary therapy. Therapy may include massage, acupuncture, hypnosis and biofeedback.
  • Medication: Prescription medicine called antidepressants can help change brain chemistry that causes depression. Antidepressants can take a few weeks to have an effect. Some antidepressants have side effects, which often improve with time. If they don’t, talk to your provider. A different medications may work better for you.
  • Brain stimulation therapy: Brain stimulation therapy can help people who have severe depression or depression with psychosis. Types of brain stimulation therapy include electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) and vagus nerve stimulation (VNS).

Depression can affect anyone, no matter their age, gender or circumstances. About 16 million Americans experience depression each year.

Women may experience depression more often than men. And your genetics or other health conditions can increase the lihood that you’ll have at least one depressive episode in your lifetime.

Can depression be prevented?

You can help prevent depression by getting enough sleep, eating a healthy diet and practicing regular self-care activities such as exercise, meditation and yoga.

If you’ve had depression before, you may be more ly to experience it again. If you have depression symptoms, get help. Care can help you feel better sooner.

Depression can be mild or severe. And it can be brief or long-lasting. It’s important to get help right away.

Without treatment, depression can:

  • Become worse.
  • Increase your chance of other health conditions, dementia.
  • Lead to self-harm or death.
  • Return, even after you start to feel better.

If you have symptoms of depression, see your healthcare provider. They can give you an accurate diagnosis, refer you to a specialist or suggest treatment options.

If you or someone you know is thinking of hurting themselves or taking their own life:


What are the signs and symptoms of depression

How Depression Is Diagnosed

You might have heard a number of terms used to describe depression. In this section, we explain what some of these terms mean.

What is clinical depression?

Clinical depression is a common term, but it is not a formal diagnosis. People sometimes say ‘clinical diagnosis’ to just mean they have been diagnosed by a doctor.

What is a depressive episode?

Your doctor might say that you are going through a 'depressive episode'. This is the formal name that doctors give depression when they make a diagnosis. They may say that you are going through a 'mild', 'moderate' or 'severe' episode.

What is recurrent depressive disorder?

If you have had repeated episodes of depression, your doctor might say that you have recurrent depressive disorder. They may say that your current episode is 'mild', 'moderate' or 'severe'.

What is reactive depression?

If your doctor thinks that your episode of depression was caused by particular stressful events in your life, they may say that it is reactive. For example, divorce, job or money worries.

This is sometimes separated from an adjustment disorder, where you may struggle with some symptoms of depression because of adapting to a major change in your life.

Such as separation from people, retirement or migrating to a new area.

What is a severe depressive episode with psychotic symptoms?

If you are going through a severe episode of depression, you may experience hallucinations or delusions. A hallucination means you might hear, see, smell, taste or feel things that others cannot. A delusion means that you might believe things that don’t match reality. These symptoms are called psychosis.

You can find more information about ‘Psychosis’ by clicking here.

What is dysthymia?

Your doctor might diagnose you with dysthymia if you have felt low for several years. But the symptoms aren’t severe enough, or the episodes aren’t long enough for a doctor to diagnose recurrent depressive disorder.

What is cyclothymia?

Your doctor might diagnose cyclothymia if you struggle with persistently unstable moods. You might have several periods of depression and periods of mild elation. These periods of depression or elation are not severe enough or long enough to diagnose recurrent depression or bipolar disorder. Cyclothymia is more commonly associated with bipolar disorder than depression.

What is postnatal depression?

Post-natal depression is a type of depression that many parents experience after childbirth. It is a common illness, which affects more than 1 in every 10 women within a year of giving birth. The partner can also experience postnatal depression. You may get symptoms that are similar to those in other types of depression.

What is seasonal affective disorder (SAD)?

SAD affects you at the same time of year, usually in the winter. Some people may find they have symptoms in summer and feel better in winter. The symptoms are similar to depression. But some people find they sleep more rather than less, and crave carbohydrates chocolate, cakes and bread. SAD can sometimes run-in families.

What is manic depression?

Manic depression is the old name for bipolar disorder. It is a different illness to depression. People with this illness have highs (mania) and lows (depression).

You can find more information about ‘Bipolar Disorder’ by clicking here.

What causes depression?

There is no single cause of depression. Different things may cause depression for different people. This section looks at some of the things that might cause depression, or depressive symptoms.

Can depression be inherited?

There is not a clear pattern to suggest that depression can be inherited. Some studies suggest that your genetics can play a part in developing depression. For example, 1 study found that particular genes may play a key role in developing recurrent depression.

Some researchers have suggested that people who have a parent or sibling with depression, have a 2 to 3 times more chance of developing depression. However, just because a relative lives with depression, it does not mean you will too.

Can my background or current situation cause depression?

Researchers have looked at whether having parents or other family members with depression can increase your chances of developing the condition. For example, a study has looked into the effects having a mother with postpartum depression can have on children as they grow up.

Research has also suggested that stressful events, such as problems at home or work, a relationship ending or financial issues may also make it more ly you will get depression.

Can my hormones or the chemicals in my body cause depression?

Changes in your hormones and chemicals in your body may cause depressive symptoms.

For example, at some point many women might find their mood is affected in the weeks before their period, called pre-menstrual syndrome (PMS). Some women may struggle with premenstrual dysphoric disorder (PMDD). PMDD is similar to depression, and has similar symptoms of PMS, but the symptoms are more severe.

Having problems with your thyroid or having low levels of Vitamin B12 may also be linked to feeling symptoms of depression.

How can lifestyle factors affect depression?

Some studies have shown that not exercising, being under or overweight can increase the risk of experiencing depressive symptoms The risk can also be increased by having fewer social relationships.

Can drugs and alcohol affect my mental health?

Both legal and illegal drugs might affect your mental health. If you take prescribed medications, it is important to make sure you take them in the way your doctor suggests.

Some people will drink alcohol because it feels it can relieve anxiety or depression. However, the evidence suggests that if you drink regularly or misuse alcohol you are at a greater risk of developing depression.

You can find more information about ‘Drugs, alcohol and mental health’ by clicking here.

Can other illnesses impact my mental health?

Depression can come with other mental or physical health conditions such as such as diabetes or cancer. Medication taken for these conditions may cause side effects which may trigger depression for some people.

Some people with brain injuries and dementia may also have changes in their moods.

You can find more information on looking after your physical health in our ‘Good health guide’ at Or call our General Enquiries team on 0121 522 7007 and ask them to send you a copy of our factsheet.


Recovery to Remission: Understanding Common Terms to Diagnose Depression

How Depression Is Diagnosed

When you’re depressed, it can be hard to decipher doctor-speak. If you aren’t clear about what your provider is saying, it can be difficult to process the information the doctor is giving you, much less formulate the questions you need to ask.

If you have been diagnosed with Major Depressive Disorder (MDD), your doctor may use terms that may not be familiar to you. Understanding the language used by healthcare providers and learning how the severity of depression is determined can help you better communicate with your doctors.

How Can My Healthcare Provider Tell Whether I Am Sad or Depressed?

Throughout life, people face many situations that result in feelings of sadness or grief: death of a loved one, loss of a job, or the ending of a relationship.

Your healthcare provider, during your appointment, will ly have an unstructured conversation with you to figure out whether you might be clinically depressed or whether you are struggling with a temporary sadness that is not depression.

While depression shares some characteristics with grief and sadness, they are not the same. Typically, people experiencing grief will feel overwhelming sad feelings in waves, according to the American Psychiatric Association. In the case of grief, self-esteem is usually maintained. 

With Major Depressive Disorder (MDD), the painful emotions tend to persist without much relief and often are paired with feelings of worthlessness and self-loathing.

The National Institutes of Health writes that Major Depressive Disorder “causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.

” These symptoms must be present for at least two weeks in order to be diagnosed with depression.

Why So Many Questions During Diagnosis?

Even though sadness and depression are different, grief can trigger depression, so healthcare providers need to be able to drill down to make a diagnosis. This is important because the medical care necessary for depression, a serious mental health condition, differs from that necessary to manage grief.

Which is why healthcare providers, if they suspect the possibility of depression, often will use a diagnostic tool a depression rating scale. They use the scale to determine whether your symptoms are indicative of depression and, if they are, the severity of the symptoms.

One of the most commonly used diagnostic tools is the Hamilton Rating Scale for Depression-17 (HAM-D-17. It focuses on 17 potential factors of depression related to mood, behavior, and symptoms. Your healthcare provider will complete the questionnaire how you’ve experienced or not experienced each factor during the past week. 

Some of the questions your healthcare provider might ask include:

  • Do you have a depressed mood (e.g., sadness, hopeless, helpless, etc.)?
  • Do you experience feelings of guilt?
  • Do you have thoughts of suicide?
  • Do you have insomnia early in the night? In the middle of the night? Early hours of the morning?
  • Do you have trouble working?

your answers and your discussion during the interview, your healthcare provider will rate the scale items from 0-2 or 0-4, depending upon the question options, for each of the 17 items, indicating the degree of severity of each factor. For example, if you aren’t experiencing a symptom, the item would receive a “0” score. Increasing scoring for each item generally indicates increasing severity of the factor. 

After your healthcare provider has completed scoring for each item, they will tally your score. Then they will determine the severity of your depression using the HAM-D17 depression severity rating scale:

  • 0-7: No Depression
  • 8-13: Mild Depression
  • 14-23: Moderate Depression
  • 24+: Severe Depression

The Complex Depression Equation: Treatment Options

After your depression severity is determined, your healthcare provider will speak with you about ways to lessen your depression (and improve your score). 

According to a quick reference guide, Treating Major Depressive Disorder (note: this links to a PDF), available from the American Psychiatric Association (APA), the severity of depression helps your healthcare provider determine an appropriate course of treatment.

The provider will ly discuss your history, including medical, psychiatric, prescription, personal, and family. Taking into consideration your clinical condition, they will decide whether your treatment should take place at home (outpatient) or in the hospital (inpatient).

Your healthcare provider then will choose an initial treatment plan, with the “aim to induce remission of the major depressive episode and achieve a full return to the patient’s baseline level of functioning,” states the APA guide. The APA advises healthcare providers to consider the following when selecting the initial treatment:

  • “Severity of symptoms
  • Presence of co-occurring disorders or psychosocial stressors
  • Biological, psychological, and environmental factors contributing to the current episode of depression
  • Patient preference
  • Prior treatment experiences”

There are many ways to treat MDD, including therapeutic medication, psychotherapy (or talk therapy), a combination of medication and talk therapy, electroconvulsive therapy (ECT) or other forms of therapy.

Additionally, some healthcare providers incorporate non-clinical approaches including diet and exercise changes.

“Bright light therapy may be considered to treat seasonal affective disorder as well as nonseasonal depression,” according to the APA guide 

The APA guide shares that your healthcare provider may consider using medication as part of treatment if you’ve responded well to antidepressants in the past; if your current symptoms continue to interfere with how you function day to day; you are agitated and/or struggle with insomnia or problems with your appetite; they think you may do better on medication long term; and if you feel comfortable taking medications for your depression.

During the medication selection process, your healthcare provider may suggest that you could be a good candidate for the GeneSight Psychotropic test.

If you are a patient who has tried and failed depression medications, it may feel the doctor is throwing darts at a dartboard from a mile away.

moving closer to a dartboard to improve the chance for hitting the bull’s eye, the GeneSight test provides genetic insight, which the doctor can use to inform medication treatment and possibly improve your chances of finally feeling yourself again.

The APA advises healthcare providers to consider using talk therapy as part of the treatment if you’ve responded well to this kind of therapy in the past; if you can find a counselor with whom you are comfortable; if you want to discuss challenges in your life or interpersonal issues; and/or if your condition is mild or moderate. 

Talk therapy only works if you feel open and comfortable talking about your depression and other aspects of your life. With talk therapy, what you typically get it is the effort you put in.  

“Psychodynamic treatment is durable over the years,” Marian Margulies, PhD, a psychologist in New York City and candidate in psychoanalysis at the Institute for Psychoanalytic Education at the NYU Medical Center told Forbes.

“The positive gains continue and grow over time as though some of the work gets further consolidated after therapy stops. This makes sense to me because it suggests that we continue to use the reflective lens in thinking about, talking about and expressing feelings about our inner lives after we end treatment.

The whole talking-with-the-therapist process gets internalized so that self-therapy picks up where the actual therapy leaves off.”

What is Your HCP Noting During Check-In Appointments?

Achieving remission can be a long, hard road for people who suffer from clinical depression.  The APA guide reports that most treatments take approximately four to eight weeks before a healthcare provider can determine whether the treatment is effective. 

Your doctor’s goal is to see a reduction in the severity of your depression symptoms. Specifically, your healthcare provider may use the following terms to discuss depression treatment goals:

  • Symptom Improvement: Any change in your HAM-D17 score (i.e., your score reducing from 22 to 18)
  • Response: A greater than or equal to 50% decrease in HAM-D17 score (i.e., your score reducing from 22 to 11).
  • Remission: A HAM-D17 score has decreased to 7 or below (i.e., your score reducing from 22 to 6). This is the ultimate goal for your healthcare provider and you.

Sometimes, though, the decided-upon treatments do not provide the relief that you need. The STAR*D trial, which evaluated depression treatment, found that a trial-and-error approach to treating depression can be slow. Fewer than 40% of the participants achieved depression remission after several weeks of the first medication protocol. 

After the four to eight weeks, if the recommended treatment does not seem to be effective, your healthcare provider may modify components. Depending on your side effects and other factors, the provider may take several different courses of action.

For example, for medication treatment, a provider may adjust dosages, change medication, or add another medication to what you are already taking. If talk therapy has started, the provider may suggest additional sessions or trying a different therapist.

The APA treatment guide suggests that treatment-resistant depression may require different and/or more intense options. Some of the treatment options could include Electroconvulsive therapy (ECT), transcranial magnetic stimulation, or vagus nerve stimulation. 

Continuation, Maintenance Phases of Depression Treatment

Once you have gotten your depressive symptoms under control, your healthcare provider will ly establish how treatment will happen during the “continuation phase.”

In many cases, according to the APA, the healthcare provider will not make any changes to treatment for at least four to nine months if the treatment is working (remission of depression symptoms). 

“Given that there is a significant risk of relapse during the continuation phase, systematic assessment of depressive symptoms, functional status, and quality of life is essential,” the guide states. 

After this period, the healthcare provider will evaluate your condition and determine whether to alter your treatment plan. 

“In general, the same treatment that was effective in the acute and continuation phases should be used for the maintenance phase. Antidepressants should generally be continued at full therapeutic dose. Reduced frequency of psychotherapy sessions may be considered,” the guide states.

Because there is a potential for relapse, the APA advises providers to continue monitoring their patients. If you relapse, there should be a plan in place regarding treatment resumption.

While clinical depression can be hard to treat, the end goal for both you and your doctor is getting you back to feeling yourself and living life as fully as possible. In clinical terms, this is defined as remission. Those reaching remission claim to feel more motivated, excited for social outings, less obsessive and more stable regarding their mood.

For more information about depression, read these GeneSight blog posts: 

Low-Grade or High-Functioning Depression

What are the Treatment Options After a Mental Health Emergency?


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