Diagnosing depression is done through a clinical evaluation conducted by a psychiatrist. Alternative, a diagnosis of depression can be given by a psychologist, in most states by a master’s level licensed practitioner such as a licensed professional counselor or clinical social worker, or by a general practitioner. Most states do allow licensed master’s-level practitioners to diagnose disorders such as depression which found in the Diagnostic and Statistical Manual of
Mental Disorders – commonly referred to as the DSM. Psychologists and psychotherapists cannot, however, prescribe medication once depression is diagnosed. In most cases you are better served seeing a mental health professional of any level for a depression diagnosis rather than seeing a general physician or other type of non-psychiatrist physician. Research studies conducted have shown that non-psychiatrist doctors are generally very inaccurate at diagnosing depression to the point that they miss over two-thirds of clinically significant cases (1).
The evaluation done when diagnosing depression involves at a minimum a clinical interview and a mental status exam. Some practitioners will also use various depression scales or inventories, however depression cannot be diagnosed solely though a scale such as this. These scales are helpful because they can give a clinician an idea of how strong someone’s depression may be, but they cannot be the only evaluation a clinician uses.
During the clinical interview the practitioner will ask many questions related to different aspects of your life, relationships, drug and alcohol use, past history, family history of mental health problems, medical history, and current symptoms you are experiencing, as well as how long you have been experiencing them for. Mental status exam questions also include assessing your current thinking patterns, mood, and emotions. Some of the MSE questions may seem nonsensical to you, but they help rule out neurological problems.
Many of the questions asked during the clinical interview may feel intrusive – especially since they are generally asked the first time you are meeting a practitioner. Most people aren’t used to going into quite that much intimate personal detail with a stranger. It is best to be as detailed and honest as you can be, even if it feels intrusive. Being thurough will help your practitioner to provide an accurate diagnosis. If you know going into the appointment that the questions will be this broad and detailed, you can prepare yourself ahead of time and avoid the stress of wondering what diagnosing depression is like.
When diagnosing depression, there are many other conditions that may look similar or produce some of the symptoms of depression. Many of the questions your practitioner will ask are geared towards ruling in or out those other conditions. Don’t be surprised if they ask you about things you’ve never experienced. Occasionally they may even send you to a medical doctor for further testing – for example there are several metabolic and thyroid problems that may create symptoms that look like depression but aren’t. Unfortunately there isn’t a simple blood test or other laboratory type test that can diagnose depression – the clinical interview and mental status exam are necessary.
The most difficult part of diagnosing depression for the majority of adults is the initial exam. After that appointment, follow ups do not feel as intrusive. If you were diagnosed by a psychiatrist, follow up appointments will generally take less than fifteen minutes and focus simply on any improvement or change in symptoms the doctor has identified, as well as refilling or changing any medications you may be prescribed. If you are diagnosed with depression when visiting a counselor or psychologist, follow up visits will be counseling sessions based on the treatment plan that you and your therapist have developed. The best treatment for overcoming depression is generally accepted to be either counseling alone or a combination of counseling and antidepressant therapy. If you choose to see a counselor first when diagnosing depression, they can provide a referral if you or they feel that antidepressants may be helpful for you. Likewise, a psychiatrist will almost always refer you to a counselor while you are being treated with antidepressants.
