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Diagnostic Evaluation and Treatment

“Your tendency is just to wait it out, you know, let it get better. You don’t want to go to the doctor. You don’t want to admit to how bad you’re really feeling.”
-Paul Gottlieb, Publisher

The first step to getting appropriate treatment for depression is a physical examination by a physician. Certain medications as well as some medical conditions such as a viral infection, thyroid disorder, or low testosterone level can cause the same symptoms as depression, and the physician should rule out these possibilities through examination, interview, and lab tests. If no such cause of the depressive symptoms is found, your physician should refer you to a mental health professional for a psychological evaluation. Keep in mind that primary care physicians offen feel obligated to try to treat every problem presented by a patient, and your physician may offer medication without a referral for therapy. That is probably not the best treatment recommendation because depression can usually be treated successfully without any medication, and all medications have potential side effects. This is particularly true if you have other health problems and are taking other medications. If there is no physical cause for your depressive symptoms, you should consult with a mental health professional.

A good mental health diagnostic evaluation will include a complete history of symptoms: This includes when they started, how long they have lasted, their severity, and whether the patient had them before and, if so, if the symptoms were treated and what treatment was given. The mental health professional should ask about your alcohol and drug use, and if you have had any thoughts about death or suicide. Further, a history should include questions about whether other family members have had a depressive illness and, if treated, what treatments they may have received and if they were effective.Finally, a diagnostic evaluation should include a mental status examination to determine if speech, thought patterns, or memory has been affected, as sometimes happens with depressive disorders. If you consult with a psychologist, you may be asked to complete an objective test to evaluate your depressive symptoms. This has the added advantage of evaluating the severity of your depression.

Treatment choice will depend on your diagnosis (there are different types of depression), the severity of your symptoms, and your preference. There are a variety of treatments that have proven effective for depressive disorders. Counseling or psychotherapy is the opreferred choice for mild to moderate depression because you are treating the cause of the depression, not just the symptoms. There are many different medications that are effective in reducing depressive symptoms as well. Even with moderate depression, some people combine medication and therapy to treat depression. Cognitive therapy has been found to be very effective in treating depression. In general, severe depressive illnesses, particularly those that are recurrent, will require a combination of therapy and medication for the best outcome.

 


Men: Depression and Bipolar Disorder: