Depression is a clinical diagnosis. There is no blood test or MRI that can diagnose it.
The health care practitioner must consider all possible physical and psychological conditions before reaching a diagnosis. Not all cases of a depressed mood are best explained by clinical depression. The task is to best put a name to a patient’s situation. Obviously, there is a lot in a name and you don’t want to give it the wrong name. But, there is also a lot not represented by the name and so the details that come out in the clinical consultation are even more important. Some common areas that need to be evaluated are:
Judging by the diagnostic criteria above, one may think that diagnosing depression and formulating a treatment plan is pretty straightforward. However, there are many different depressive disorders and many different subtypes all of which are important to appreciate when reaching a diagnosis and designing a treatment plan. And then again, that’s assuming it is depression. Perhaps the patient’s situation better matches with another physical or psychological condition and the treatment plan can be most efficiently treated in another way.
For example, a patients with chronic sinusitis or iron deficiency anemia can present with symptoms of depression and even satisfy the diagnostic criteria. But, the most efficient treatment would be to treat the chronic sinusitis or iron deficiency anemia, possibly in addition to other depression-oriented evaluations/treatments. Treating these conditions purely as depression may leave patients and health care practitioners feeling unsatisfied.
Nationally or regionally representative community surveys in 14 countries found that the estimated lifetime prevalence of major depression and persistent depressive disorder (dysthymia) in adults was 12 percent (Kessler et al., 2011).
Why is the prevalence of depression about double in the developed world vs. the developing world?
Researches think it is due to cultural, genetic and statistical factors (Weissman et al., 1996; Gureje et al., 2007).
In the United States, the chance of an adult to have major depression and persistent depressive disorder is approximately 6 and 2 percent, respectively (Karg et al., 2015)
Depression seems to be more common in females
In two separate meta-analyses including nationally representative samples with over 1.7 million people each (a large number of participants!), researchers found that females were 1.95 times more likely to have major depression than males. They found that depression symptoms and diagnoses peaks in adolescence at 12-year-old when females are 2.37 times more likely than 12-year-old males to have clinical depression than males. The gender gap then narrows and remains stable in adulthood (Salk et al., 2017). Statistics Canada had similar findings.
Theories as to why this is
It’s important to state that more studies are needed here but researches have a few theories to explain the findings above.
1. Maladaptive. Here, the emotions are deviant and not helpful at all. They can be seen as neurotic.
E.g., George Constanza from Seinfeld, Episode “The Pilot” (1993).
George Costanza: What if the pilot gets picked up, and it becomes a series?
Dana Foley: That would be wonderful, George. You’ll be rich and successful.
George Costanza: Yeah, that’s exactly what I’m worried about. God would never let me be successful. He’d kill me first. He’d never let me be happy.
Dana Foley: I thought you didn’t believe in God.
George Costanza: I do for the bad things.
Dana Foley: Do you hear what you’re saying? God isn’t out to get you, George. What… What is that on your lip?
George Costanza: What?
Dana Foley: It’s like a discoloration. It’s white.
George Costanza: [looks in a mirror] Yes. Yes, it’s white. Why is it white?
Dana Foley: You’d better get that checked out.
George Costanza: “Better get that checked out”?
Dana Foley: I would.
George Costanza: What kind of a therapist are you? I’m telling you I’m scared that something terrible is gonna happen to me. Right away you start looking for tumors?
Dana Foley: I’m trying to help.
George Costanza: What are you, like a sadist? No matter how bad somebody feels, you can make ’em feel worse? I’ll bet you’re rootin’ for the tumor!
Dana Foley: I think you’d better go.
George Costanza: Well, I’m going, baby! I’m goin’!
2. Adaptive. Here, the emotions are a messenger, like a carbon monoxide detector sounding. Although it’s unpleasant, it’s beneficial. Will you check in and hear what it’s trying to tell you?
E.g., A patient of the clinic once was getting extreme anxiety while driving. His history and physical exam showed a pattern of deficits that localized the majority of his problems to his right parietal lobe.
Doctor: Might your anxiety be trying to tell you something?
Patient: I don’t think so, I just feel like I’m losing control
Doctor: Were you aware that patients with parietal lobe deficits are more prone to car accidents?
Patient: No I didn’t.
Doctor: Isn’t that amazing, but your body seemed to intuitively know.
Patient: Perhaps it’s just telling me to be careful and I’m misinterpreting it (the emotions) as attacking me.
Within a week, this patient accepted his anxiety as a messenger telling him to be careful and he saw it as such. His anxiety phased out by week 2 afterthis conversation. By week 6 after this conversation, he was asking us as to whether he could go on a 10 hour road trip (to which we said no, but for other reasons related to visual-vesitublar mismatch).
3. Instrumental. You use your emotions as a tool to get what you want.
E.g., From the movie “Training Day”, Ethan Hawke says to Denzel Washington’s character…
“It’s all about smiles and cries. Yeah. You gotta control your smiles and cries, because that’s all you have and nobody can take that away from you.”
E.g., Like you crying to get out of a speeding ticket.
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