(TORONTO, ON) – You are perhaps the least qualified person to determine if you are depressed. No offence intended, but before you surrender to your own analysis I would urge you to bypass your family doctor and try and link up with a psychiatrist who has the experience and tools to deal with the issue.
The diagnosis of depression is crucial. Its treatment is more controversial. The question is, how can you determine if depression is dinging you?
Before anti-depressants are suggested you must really go through some objective analysis as to whether you are actually depressed. This must be done before anti-depressants are prescribed. I strongly advise that anti-depressant prescriptions by your family doctor should be avoided.
Drug companies ferociously court both General Practitioners and psychiatrists with the latest anti-depressant medications to the tune of $22,000 per doctor annually. I’ll take my chances with a careful psychiatrist over a over swamped GP.
A fastidious psychiatrist will have many meetings with you to determine if your physical health presents any barriers to prescribing anti-depressants. Your physical health can throw some obstacles which may have lead to drugs being prescribed that, in themselves, can cause anxiety and depression.
For example, cardiac drug Amiodarone is notorious for causing sub-clinical hyperthyroidism, which is a factor in creating anxiety and depression. Is your psychiatrist patient and thorough enough to pick up on this? Furthermore, existing drugs you are taking my be a dangerous mix with anti-depressants.
A great psychiatrist does not pump you up with drugs without first evaluating any physical conditions that anti-depressants may worsen. A great psychiatrist also asks your permission to prescribe anti-depressants and warns you of possible side effects and the effects of discontinuance. And, a great psychiatrist also asks you continually if you are tolerating the anti-depressant and offers alternative medications if the initially prescribed drug is causing you grief.
And, it is also possible that mindfulness and/or cognitive behavioural therapy should be offered in addition to, or in substitution of, anti-depressants.
At the end of the day, is there any real objective method in determining if you are depressed? My thoughts on this are, not really.
The first step is often a Beck Depression Inventory questionnaire, which I have been informed by several psychiatrists is extremely effective, along with Diagnostic and Statistical Manual of Mental Disorder guidelines, in determining the existence of depression. The BDI, as it is known, is value laden and riddled with subjectivity as to what constitutes depression.
Of course, it was not dreamt up, but had input from the psychiatric community.
You can always delve into the BDI questionnaire on the internet for further details, but it starts off by asking 22 questions about how you feel. Each answer results in a numerical score. The worse you feel about yourself the higher the numerical score and the more depressed you are.
The questionnaire asks how you feel about certain topics and you are graded between 0 and 3 on each category.
- Past Failure
- Loss of Pleasure
- Guilty Feelings
- Punishment Feelings
- Suicidal Thoughts and Wishes
- Loss of Interest
- Loss of Energy
- Changes in Sleeping Pattern
- Changes in Appetite
- Concentration Difficulty
- Tiredness or Fatigue
- Los of Interest in Sex
The BDI then asks about degrees of feelings with choices being ‘Not at All’, ‘Mildly (It did not bother me much)’, ‘Moderately (It was very unpleasant but I could stand it)’, and ‘Severely (I could barely stand it)’.
- Numbness or Tingling
- Feeling Hot
- Wobbliness in Legs
- Unable to Relax
- Fear of the Worst Happening
- Dizzy or lightheaded
- Heart Pounding or Racing
- Feelings of Choking
- Hands Trembling
- Fear of Losing Control
- Difficulty Breathing
- Fear of Dying
- Indigestion or discomfort in abdomen
- Face Flushed
- Sweating (not due to heat)
In addition to the BDI, the psychiatrist will review the Diagnostic and Statistical Manual of Mental Disorder, otherwise known as the DSM, which assists in making a diagnosis and providing a treatment plan. The DSM is subject to very strong criticism due to the mushrooming of mental illness that it has diagnosed, almost as if DSM was the creator of mental illnesses.