Getting a Depression Diagnosis

Depressive disorder—also known as depression—is a mental health condition where a person experiences sadness and hopelessness, among other feelings, for two or more weeks. These feelings can affect your thoughts, moods, and behaviors. Symptoms of depressive disorder can make it difficult to complete daily tasks and reduce your quality of life.

Experiencing depression is common. In fact, in a year’s time, an estimated 6.7% of adults experience depression, while 16.6% of adults develop depression at some point in their lifetime.

Depression may arise because of a combination of genetic, psychological, and environmental factors. As a result, your healthcare provider may use interviews based on specific criteria, questionnaires, and lab testing (as needed) to provide you with an accurate diagnosis for depressive disorder.

Other than healthcare providers like primary care physicians (PCPs), a variety of professionals can also diagnose depression, such as:

• Psychiatrists: Doctors who specialize in mental, emotional, and behavioral disorders
• Psychologists: Doctors who specialize in mental health conditions and provide counseling and therapy 
• Psychiatric or mental health nurses: Nurses with specialized mental health training like advanced practice registered nurses (APRNs), certified nurse practitioners (CNPs), and clinical nurse specialists (CNSs)
• Licensed clinical social workers (LCSWs): Social workers with specialized mental health training 
• Licensed professional counselors (LPCs): Counselors (e.g., clinicians or therapists) with education and expertise in mental health

Healthcare providers will check how severe your depressive symptoms are, how long symptoms have been happening, and if there are other related conditions that may be influencing depressive moods.

Diagnostic Criteria for Depression

Healthcare providers begin the diagnostic criteria by referring to the criteria from the "Diagnostic and Statistical Manual of Mental Disorders," or the DSM.

Over time, the symptoms and categories of depression have changed with the various editions of the DSM. In the DSM-5, the signs of depressive disorders are as follows:

• Sadness or depressed mood
• Loss of interest or pleasure in activities that you used to enjoy
• Appetite changes resulting in weight changes (losing or gaining weight, but not from dieting)
• Sleep problems like not getting enough or getting too much sleep
• Increased fatigue or having no energy
• Slow movement (that others have noticed) or increased purposeless movement (e.g., inability to sit)
• Feelings of guilt, hopelessness, or worthlessness
• Difficulty concentrating or making decisions
• Thoughts related to death or suicide

A clinical diagnosis of depression requires that a person has five of the nine symptoms of depressive disorder (listed above). Having a depressed mood or a loss of interest in activities must be one of the symptoms. You must also have depressive symptoms for at least two weeks, occurring most days than not, to receive an official diagnosis.

Your healthcare provider will determine how severe your experience of depression is based on how painful or disabling your symptoms have been and how long the symptoms have been present. 

Clinical Interview

Information about your history is important for diagnosing depression. Your healthcare provider will learn about your background in the form of an interview.

A clinical interview can help your provider get an idea of your thoughts, moods, and how you interact with other people. A healthcare provider or mental health professional will ask questions about your past medical history, family medical history, and social history (e.g., lifestyle habits, stressors, and history of substance use).

If the interview is conducted by a mental health professional, it will likely contain more in-depth questions about your emotions, symptoms, and recent traumatic or stressful life events.

With your written consent, a mental health professional may also choose to interview individuals who frequently interact with you—such as your family, friends, or coworkers—to better understand your behaviors. This generally occurs if a provider is having difficulty understanding your symptoms or needs more context to provide you with an accurate diagnosis.

Questionnaires

Another method for diagnosing depressive disorders is via questionnaires. The questionnaires are assessments you can either fill out by hand or questions that your provider will ask you orally. The results from the questionnaires give your healthcare provider information that can guide their diagnosis and possible treatment options, if needed.

Examples of possible questionnaires that a provider may give you are the:

• Beck Depression Inventory (BDI): A 21-question self-report test that screens for depression and helps determine the severity of your depression
• Beck Hopelessness Scale: A 20-question self-report measure for people between the ages of 17 and 80 that tests a person’s future expectations and hopes for life
• Center for Epidemiologic Studies Depression Scale (CES-D): A 20-question self-report assessment that is designed to screen for depression based on symptoms you may have experienced in the past week
• Hamilton Depression Rating Scale (HAM-D): A 21-question scale that asks you about general mental health-related symptoms and behaviors
• Patient Health Questionnaire (PHQ-9): A self-report measure that your provider can use to screen for depression  
• Social Adjustment Scale-Self-Report (SAS-SR): A 54-question self-report questionnaire for people aged 17 and older that asks about your social habits and functioning

Screening for Related Conditions

Sometimes, other health conditions can mimic symptoms of depression (similar conditions) or appear at the same time that depression does (co-occurring conditions).

Similar Conditions

The following list contains other medical or mental health conditions that can have the same or similar symptoms as depressive disorders:

• Adjustment disorders: Trouble coping with stressful live events or sudden changes
• Anemia: Lack of healthy red blood cells in the body
• Anxiety: Racing thoughts and extreme feelings of worry
• Chronic fatigue syndrome (CFS): Persistent fatigue, despite getting enough sleep
• Dementia: Loss of memory, judgment, thinking, and problem-solving abilities
• Demoralization: Feeling down and discouraged
• Dissociative disorders: Coping with mental health concerns through disconnection or escaping reality
• Grief: Deep or emotional response to experiencing loss
• Hypoglycemia: Low blood sugar
• Hypopituitarism: Inability of your pituitary gland (in your brain) to make enough hormones
• Hypothyroidism: Underactive thyroid
• Parkinson’s disease: Brain disorder that causes uncontrollable movements
• Schizophrenia: Experiencing hallucinations, delusions, and disordered thinking or behaviors
• Substance use disorders: Recurrent or persistent use or dependency on alcohol, drugs, or other substances

Keep in mind: there are no laboratory tests that can diagnose depression. However, healthcare providers may use physical exams and lab tests like complete blood cell (CBC) counts, liver function tests (LFTs), or thyroid-stimulating hormone (TSH) tests to help rule out medical conditions that may be causing symptoms of depression.

In some cases, your provider can order imaging tests, such as computed tomography (CT) scans or magnetic resonance imaging (MRIs), to test for brain-related conditions. Typically this occurs when your provider suspects you may have an injury, mass, or dysfunction in your brain structure.

Co-occurring Conditions

Other medical or mental health conditions (called comorbid or co-occurring conditions) can occur with depression, and subsequently, increase the severity of your symptoms. Conditions that can co-occur with depression include, but are not limited to:

• Arthritis
• Autoimmune disorders (e.g., multiple sclerosis, Crohn’s disease, psoriasis)
• Cancer
• Central nervous system disorders (e.g., Alzheimer’s disease)
• Diabetes
• Heart conditions (e.g., heart disease, high blood pressure)
• HIV
• Obesity
• Respiratory disorders (e.g., asthma, bronchitis)

A Quick Review

Healthcare providers and mental health professionals can give you an accurate diagnosis for depressive disorder. They may use a combination of questionnaires and interviews to learn about your symptoms, medical history, and lifestyle. If needed, a provider can also order blood tests or imaging tests—which are most often used to rule out other conditions.

While dealing with depression can be difficult, the good news is that the condition can be treated. So, don't wait to seek care from a provider. Getting a diagnosis can help you figure out a treatment plan that can reduce your symptoms and improve your overall quality of life.