Depression can be passed on to children

How is depression diagnosed?

Conversation: recognizing signs of depression

When you have decided to see a doctor or a psychotherapist, you will first be asked a few questions.

Recognizing depression is not always easy, however. Many depressed people find it difficult to talk about their emotional state on their own. Often they cannot classify their problems. One reason for this is that uncertain physical symptoms can be linked to depression. Therefore, some people believe that their symptoms are due to a physical illness. For this reason shouldIn the opinion of the expert group, ask doctors and psychotherapists specifically for signs of depression.

A simple test can provide initial indications of depression: the so-called "two-question test":

  1. In the past month, have you often felt down, sad, depressed, or hopeless?
  2. In the last month, have you had significantly less desire and enjoyment in things that you normally enjoy doing?

If you answered “yes” to both questions, it could be a sign of depression. According to the expert group shouldthen your doctor or psychotherapist will take a closer look at the signs of depression. To do this, he or she will speak to you in more detail and ask you questions about the individual complaints. Your doctor or psychotherapist can use certain conversation guidelines to help. You may also be asked to fill out a questionnaire.

The main characteristics of depression (Main symptoms) are:

  • depressed, depressed mood;

  • Loss of interest and joylessness;

  • Lack of drive and fatigue.

There are also several Side symptoms. They are also recorded precisely because they help determine the severity of the disease.

The side symptoms of depression include:

  • decreased concentration and alertness;

  • decreased self-esteem and self-confidence;

  • Feelings of guilt and worthlessness;

  • exaggerated fear of the future or "black eyesight";

  • Suicidal thoughts or attempts, self-harm;

  • Sleep disorders;

  • decreased appetite.

Depression is diagnosed when there are at least two major and two minor symptoms. The symptoms must last for at least two weeks. When making the assessment, it is not only your current state of mind that is important, but also the course of the last few weeks.

In addition to typical emotional stress, physical complaints also indicate depression. In the case of shortness of breath or cardiac arrhythmias, for example, you may not initially think that these can also have psychological causes. This is why your doctor or psychotherapist wants to find out as much as possible about your physical condition.

The physical symptoms that indicate depression include:

  • general physical exhaustion, fatigue;

  • Sleep disorders (difficulty falling asleep and / or staying asleep);

  • Loss of appetite, stomach pressure, weight loss, digestive problems such as constipation (constipation) or diarrhea (diarrhea);

  • Headache or other pain, for example back pain;

  • Feeling of pressure in the throat and chest, tightness in the throat (so-called "globe feeling");

  • Shortness of breath and disorders of the heart and circulation, such as cardiac arrhythmias or palpitations;

  • Dizziness, flickering before the eyes, blurred vision;

  • Muscle tension, sudden shooting pain;

  • Loss of sexual interest, no menstrual period, impotence, sexual dysfunction;

  • Memory and concentration disorders.

The appearance of depression also depends on cultural factors. In some cultures, for example, emotional complaints are mainly expressed physically. This sometimes makes it difficult for doctors and psychotherapists to recognize depression. Because of that shouldIn the opinion of the expert group, culture-specific factors and peculiarities of people who have immigrated to Germany should be taken into account in the detailed discussion and during the investigation. This also applies to the subsequent treatment.

When your doctor or psychotherapist is talking to you, he or she will also pay attention to other things, such as behavior, clothing, or language. For example, a quiet voice, a lack of emotions or a hunched, powerless posture can be indicators of an illness.

Sometimes it can be helpful to interview relatives or close caregivers as well. For example, what they tell you can help raise the signs in the elderly.

The conversation is the most important "instrument" to find out whether you are suffering from depression and how severe it is. The more openly and precisely you answer, the better your doctor or psychotherapist can tell whether you are depressed. This is important because treatment depends on how severely you may be ill.

If you have been diagnosed with a depressive illness, the next steps will be discussed with you and, if necessary, treatment will be initiated (more on this in the chapter "Excluding other illnesses"). In most cases, depression can be treated well.

Possible questions

A few sample questions that have proven useful and well suited are listed below for you. So you can roughly imagine how the conversation could go. When you are about to visit the practice, these questions can help you prepare - or simply serve as a stimulus to think about yourself:

Possible questions during the conversation

"Have you felt down or sad in the past two weeks?"

"Were there times when your mood was better or worse?"

"Have you recently lost interest or pleasure in important activities (job, hobby, family)?"

"Over the past two weeks, have you had the feeling almost all the time that you haven't felt like doing anything?"

"Have you lost your energy?"

"Do you feel tired and exhausted all the time?"

"Do you find it difficult to do everyday tasks as you normally would?"

"Do you have trouble concentrating?"

"Do you have trouble reading the paper, watching TV, or following a conversation?"

"Do you suffer from a lack of self-confidence and / or self-esteem?"

"Do you feel as confident as usual?"

"Do you blame yourself a lot?"

"Do you often feel guilty for everything that happens?"

"Do you see the future blacker than usual?"

"Do you have any plans for the future?"

"Are you feeling so bad that you think about death or that it would be better to be dead?"

"Did you have or do you have specific plans to harm yourself?"

"Did you try to harm yourself?"

"Is there anything that is keeping you alive?"

"Has anything changed in your sleep?"

"Do you sleep more or less than usual?"

"Have you had more or less appetite lately?"

"Did you gain or lose weight unintentionally?"

The doctor or psychotherapist will discuss such topics with you. It is also possible that the conversation starts with unanswered questions, such as why you came, how you are or what your complaints are. Then you may be better prepared by answering the questions listed above to bring your own thoughts and observations into the conversation. However, you may also want to address completely different things first - recent experiences, for example, or stressful situations in your life story.

Degrees of severity

A distinction is made between mild, moderate and severe depression. The severity depends on the number of main and secondary symptoms:

  • From a "light" depressive episode one speaks when two main and two secondary symptoms last more than two weeks.

  • If there are two main symptoms and three to four secondary symptoms, one speaks of one moderatedepression.

  • Three main symptoms and four or more secondary symptoms characterize one major depression.

The treatment options for all three degrees of severity are different (more on this in the chapter "What the guideline recommends"). It is therefore important that as many signs of illness as possible are identified through questions.

The following overview gives you an idea of ​​how professionals determine the severity of depression.

Figure 2: Depression: Symptoms and Severity Levels
(Please click on the image to enlarge it)

Exclude other diseases

If you have been diagnosed with signs of depression, it does not necessarily mean that you have depression. Many of these signs are also part of the clinical picture in other mental disorders. Fatigue or sleep disorders can also occur, for example, with physical illnesses. Because of that shouldIn the next step, in the opinion of the expert group, ask your doctor or psychotherapist questions about other possible diseases and your medical history in order to differentiate them. Physical examinations can be added. They provide clues to a possible physical illness as the cause of the depression.

On the other hand, the diagnosis can be difficult, especially in people with severe physical or mental illnesses or in the elderly, because they can experience general weakness or sleep disorders regardless of depression.

Older people in particular often complain of dizziness or impaired concentration and memory. If such changes are noticed, doctors and psychotherapists should always think about the onset of dementia.

Medication that you are taking or have discontinued can also trigger depression or worsen the symptoms. It is therefore important for the examiner to know whether you are taking any medication and, if so, which one.

It is therefore helpful if you compile a list of all medications you are currently taking and bring them with you to the doctor's visit. The list also includes medicines that you bought without a prescription, such as dietary supplements or herbal products. You can also just wrap up all the medicine packs.

Tip - medication plan

People who are taking or using at least three prescribed medications at the same time have a statutory right to a medication plan that is understandable to them. You will receive this from your treating doctor.

Further information on the medication plan and an example template can be found here:

If you have been diagnosed with depression, then shouldIn the opinion of the expert group, your doctor or psychotherapist should check carefully whether you have any physical concomitant illnesses. In addition shouldhe or she will check whether you are taking any medication or other substances that may be associated with symptoms of depression. According to the expert group shouldman youRefer to an appropriate specialist or psychotherapeutic practice if there is evidence of an illness that requires treatment.

2nd edition, 2016. Version 2