Depression in Adults - Symptoms and Diagnosis
Everyone has heard a lot about depression, but depression is actually more than just being unhappy. Understanding more about depression can help you quickly recognize if you are experiencing any symptoms of depression, reducing the likelihood of delayed treatment.
Depression - Symtpoms and Diagnosis
Other pages related to Depression:
抑鬱症 —— 藥物治療 Mediations for Depresion
抑鬱症 —— 噴鼻式谷氨酸類藥物（Esketamine）Esketamine for Depression
抑鬱症 —— 腦磁激（rTMS）rTMS for Depression
What Are the Symptoms of Depression? Four Major Categories of Depression Symptoms
Depression is a term that many people are familiar with, but depression is not just about being unhappy. Understanding more about depression can help us detect symptoms early and reduce the chance of delayed treatment. Below, we share the four major categories of depression symptoms:
Emotions
When depression strikes, a person's mood can become extremely low and unhappy. This unhappiness lasts longer than usual and typically needs to persist for two weeks to meet the diagnostic criteria for depression. Additionally, people with depression may lose motivation and interest in things they previously enjoyed. They often have low energy levels, appearing tired and lethargic.
Physical Functioning
Depression can affect our daily physical functioning, making it worse than usual. Sleep is one aspect; people with depression may have trouble falling asleep, wake up earlier than usual, or sleep excessively. Their appetite may also worsen, leading to weight loss. Some patients may move more slowly than usual and engage less in social activities and outings.
Cognitive Function
Cognition refers to what a person is thinking. Depression can affect a patient's thoughts, making them different from usual. Even if someone is typically confident, their self-esteem may drop during depression. They might spend all day blaming themselves or feeling guilty without reason, even for things unrelated to them. Some patients may have reduced concentration, and some may have suicidal thoughts.
Sensory Symptoms
Emotions can also affect a person's sensory experiences. Sometimes, patients may not complain to their doctors about feeling low and unhappy, but they might constantly mention chest pain, muscle pain, or gastrointestinal discomfort.
These patients usually do not associate their discomfort with depression but rather with some physical illness, hoping their doctor will refer them to different specialists. However, the outcome is often disappointing, as numerous tests fail to find the cause.
Common sensory symptoms include pain, muscle pain, fatigue, dizziness, numbness, neck pain, and lower back pain. These physical discomforts can also affect their daily lives, including their appetite, daily activities, and sleep.
Conclusion
Depression symptoms are not just about feeling low. If you suspect you have symptoms of depression that are affecting your life, please contact a professional for an assessment as soon as possible.
Is being unhappy the same as depression? The 4 dimensions doctors use to diagnose depression
Many people have heard of depression, but what exactly constitutes depression? "Everyone is unhappy, does that mean everyone is depressed?"
Is extreme unhappiness, constant sadness, and frequent crying considered depression? Is unbearable pain from a breakup considered depression? What criteria do doctors use to determine if someone is depressed?
In fact, to determine if someone is depressed, doctors generally make their decision based on four aspects.
The first is the number of depressive symptoms.
The more depressive symptoms there are, the higher the likelihood that the patient is suffering from depression. Common depressive symptoms include low mood, lack of motivation, lack of confidence, and decreased sleep quality. Doctors will count these symptoms one by one to assess the severity of the patient's depression.
The second is the type of depressive symptoms.
Certain symptoms are more common in patients with severe depression, such as psychomotor retardation, where the patient's movements are very slow, and they appear tense. Some patients with severe depression may also experience psychotic symptoms, such as hearing nonexistent voices, seeing nonexistent visions, or constantly suspecting that others are plotting against them. These types of symptoms indicate the severity of the depression.
The third is the impact of depressive symptoms on life.
Some patients' quality of life is greatly affected by depression. They may be unable to attend school or work, preferring to stay at home doing nothing, and even unwilling to interact properly with others, thereby affecting their social life and relationships with family.
The fourth is the duration of depressive symptoms.
Everyone can feel unhappy, but if the unhappiness lasts only a day or two and then quickly returns to normal, it cannot be considered depression. On the other hand, if the symptoms persist for a considerable length of time, lasting several weeks or even months, the situation may be more serious.
If you notice similar symptoms in yourself or a friend, please pay attention to these four dimensions. If the situation is similar, it is advisable to seek medical treatment as soon as possible.
The Gray Area Between Normalcy and Depression — Dysthymia
Previously, we discussed how doctors diagnose depression based on four different dimensions: the number, duration, type, and severity of depressive symptoms.
However, a problem arises. Some people are indeed not very happy, but their depressive symptoms may not be numerous. Sometimes, it might just be a slight unhappiness or a lack of appetite compared to usual, and these symptoms do not significantly impact their lives. The number and severity of their depressive symptoms do not meet the diagnostic criteria for depression. So, should we consider these patients as depressed or not?
In fact, besides the diagnosis of depression, diagnostic guidelines also include other disorders to describe patients in this gray area between depression and normalcy. One such disorder is called Dysthymia.
Dysthymia has many different translations. The first translation is "minor depression." This translation is not ideal because depression itself already has varying degrees of severity. So, is minor depression the same as mild depression? This can lead to many misunderstandings.
Another interesting translation for Dysthymia is "dysthymic disorder" or "persistent depressive disorder." This translation is quite vivid. If you have ever seen patients of this type, you will notice that their mood is indeed quite poor. They tend to view things very negatively, often magnify small matters, and are frequently troubled by trivial issues. For 365 days a year, they spend most of their time continuously immersed in their pessimistic world.
Compared to patients with actual depression, although their depressive symptoms are milder, they are much more persistent. Generally, patients need to have symptoms of Dysthymia for at least two years before we can diagnose them with dysthymic disorder.
The treatment methods for dysthymic disorder are similar to those for depression. Doctors usually start with antidepressants to alleviate the symptoms. However, from clinical experience, mental illnesses require mental remedies. What patients with dysthymic disorder need most is to resolve past emotional knots and learn to see the world from a different perspective.
Simultaneous Occurrence of Depression and Schizophrenia Symptoms? Introducing Psychotic Depression
Sometimes, patients with depression may exhibit symptoms of both depression and schizophrenia. In such cases, the patient may be suffering from psychotic depression.
Psychotic depression can be understood as one type of severe depression. Many patients with severe depression experience symptoms of schizophrenia, but even so, most similar cases are classified as depression rather than schizophrenia or schizophrenia spectrum disorders.
So, if a patient exhibits symptoms of both depression and schizophrenia, how can we distinguish whether the patient has depression or schizophrenia?
First, we can categorize based on the timing of symptoms. Patients with psychotic depression typically experience depressive symptoms first, followed by schizophrenic symptoms later on. In contrast, patients with schizophrenia or schizophrenia spectrum disorders usually experience symptoms such as auditory hallucinations or delusions initially. They are often troubled by these symptoms, which can lead to emotional symptoms.
Second, we can categorize based on the type of schizophrenic symptoms. The schizophrenic symptoms experienced by patients with psychotic depression are mostly mood-congruent, such as delusions of persecution or nihilistic delusions. In contrast, the schizophrenic symptoms experienced by patients with schizophrenia are more diverse and may not necessarily be mood-congruent.
Third, in some cases, the schizophrenic symptoms of patients with psychotic depression can improve alongside depressive symptoms after treatment with antidepressants. In contrast, depressive symptoms in patients with schizophrenia often persist even after taking antidepressants.
How should psychotic depression be treated? Is it the same as treating depression?
The treatment for psychotic depression differs from that of regular depression. Patients generally require higher doses of antidepressants, and the treatment duration is longer than that for regular depression.
In addition to antidepressants, patients also need to take antipsychotic medications to control schizophrenic symptoms. Generally, the dosage of antipsychotic medication for these patients is lower than that for patients with schizophrenia.
However, many cases of psychotic depression are also classified as treatment-resistant depression. In addition to antidepressants and antipsychotics, patients may need to undergo other types of treatments, including transcranial magnetic stimulation, Esketamine, or electroconvulsive therapy.
Is it depression or ADHD? What to do if you suspect a misdiagnosis?
As mentioned before, the symptoms of depression can be divided into four main categories, one of which relates to the cognitive function of the patient. Depression affects a person's thought patterns and can also impact their concentration and short-term memory.
However, children with Attention Deficit Hyperactivity Disorder (ADHD) often develop depression due to the impact of their symptoms on learning and work. In fact, patients with ADHD are more likely to develop depression than the general population.
In the previous generation, there was no concept of ADHD, and many ADHD patients were not diagnosed even after growing up. When a patient exhibits symptoms of both inattention and depression, how should doctors make a diagnosis?
The Rashomon Case
(The case is from a forum post, with content edited)
"I have always had issues with inattention, which has affected my work performance, and subsequently, I developed symptoms of anxiety and depression. After seeing a doctor, I was diagnosed with depression, with the belief that I was not handling stress well. However, I believe that the root cause of my depression is inattention, as my work ability was affected, my confidence kept dropping, and I became reluctant to interact with others. But the doctor only thinks I have simple depression, and inattention is just one of the symptoms of depression. My opinion differs from the doctor's; how should I handle this?"
Is it the chicken or the egg?
To determine whether a patient has depression or ADHD, the timing of ADHD symptoms is crucial. If the patient's symptoms of inattention were present during childhood, the patient is more likely to have ADHD.
However, this judgment can be challenging in practice. Since we cannot go back in time, it is difficult to determine based on the patient's brief statements whether they had ADHD during childhood. In such cases, doctors may need to invite the patient's family members to be present during the consultation to provide additional information to aid in the diagnosis.
What should I do if the doctor refuses to listen to me?
If you are being followed up at a public hospital, you can try asking the doctor to refer you to the Adult ADHD Clinic at the Tan Tock Seng Hospital Rehabilitation Centre. The clinic accepts suspected cases from all regions, but the waiting time is relatively long.
If you are being followed up at a private clinic, it is even simpler—just switch to a different doctor to solve the problem.
Depression is not depression? Other physical illnesses can also cause depressive symptoms
Previously, we mentioned that before a patient is diagnosed with depression, they must meet certain diagnostic criteria. However, sometimes even if they meet all the diagnostic criteria for depression, they may not necessarily be suffering from depression. In fact, many other physical ailments can also produce symptoms similar to depression.
Thyroid Dysfunction
We have seen new patients, and after going through their entire medical history, we usually perform a blood test. One of the items in the blood test is quite special, which is thyroid hormone. Why do we need to check the patient's thyroid hormone? This is because some endocrine issues, such as a decrease in thyroid function, can cause patients to exhibit symptoms similar to depression, including fatigue, lack of energy, weight gain, and so on. The appearance of these symptoms does not mean that there is a problem with the patient's brain; as long as we resolve their endocrine system issues, these so-called depressive symptoms will be resolved easily.
Cancer and Chronic Infections
What other physical conditions can cause depressive symptoms in patients? We can imagine that if the body is fighting a battle every day, every cell should be quite tired, with no extra energy to maintain everything needed for daily work and school. In this situation, people become fatigued, lethargic, and emaciated, appearing like depression patients.
What diseases cause our bodies to be in a state of constant battle? Cancer is one of them, and there are also patients with chronic infections, such as syphilis, AIDS, tuberculosis, and so on, which are common examples.
Anemia
Why does anemia cause depressive symptoms in patients? Because hemoglobin in the blood can supply the oxygen we inhale to every cell in our body. This oxygen, through chemical reactions, allows the energy from glucose and fatty acids in food to be released, enabling our bodies to function normally.
In patients with anemia, their hemoglobin cannot supply enough oxygen to every cell in the body, causing them to appear very tired, always lacking spirit, not wanting to go out, and not wanting to talk to people. This is quite similar to depression.
There are many causes of anemia, which we will not go into detail here, but the most common examples are iron deficiency and excessive blood loss. Some women with irregular periods or heavy flow can become anemic, and deficiencies in folic acid or vitamin B are also culprits of anemia.
As mentioned earlier, if there is not enough oxygen supply, patients may exhibit pseudo-depressive symptoms. In addition to anemia, some cardiovascular or respiratory diseases may also be possible causes.
Other Neurological Diseases
The source of depression is in our brains, and intuitively, if there are other problems in the brain, it is naturally possible to affect a person's cognition and emotions, causing depressive symptoms in patients. Some diseases originally belonging to neurology, such as Parkinson's or Alzheimer's, can also exhibit depressive symptoms in patients.
Is Treatment Ineffective If Medication Doesn't Work? A Discussion on Treatment-Resistant Depression
According to the general definition, if a patient has tried two different categories of antidepressants and the symptoms of depression still cause distress, the patient can be considered to have treatment-resistant depression (TRD).
Other Possibilities for Treatment-Resistant Depression
However, sometimes things are not that simple. To determine if a patient has treatment-resistant depression, doctors must first ensure the patient's adherence to medication. If the patient does not take the medication at all, how can it be considered treatment-resistant?
Additionally, doctors need to know if the patient previously took an adequate dose of antidepressants and for how long. Generally, antidepressants take at least one to two weeks to take effect. If the patient gives up after just a few days, it is naturally impossible to test the efficacy of the antidepressants.
Sometimes, other physical conditions can also cause depression, such as anemia, hypothyroidism, and so on. If these underlying issues are not resolved, taking any amount of antidepressants will not alleviate the symptoms of depression.
Moreover, other psychiatric disorders can also cause symptoms of low mood, such as schizophrenia, personality disorders, and so on. The treatment methods for these diseases differ from those for depression, and using only antidepressants may not necessarily help the condition.
Treatment for Treatment-Resistant Depression
"Treatment-resistant" depression is not "untreatable" depression. With patience, a solution can always be found. In addition to switching to another antidepressant, some doctors may also try other types of psychiatric medications, such as antipsychotics and mood stabilizers. Besides medication, electroconvulsive therapy (ECT), as well as newer treatment methods like repetitive transcranial magnetic stimulation (rTMS) and nasal spray medication Esketamine, are also options for treating treatment-resistant depression.
Suspect you might have depression? The PHQ-7 questionnaire can help!
We might worry about whether we have depression. Before seeing a doctor, complete the questionnaire below, and the computer will automatically calculate your score, giving you another reference point.
Interview with a Psychiatrist! How long does one have to be unhappy to be considered depressed? Besides a bad mood, what other symptoms are there? Is depression the hardest to deal with in the elderly and children?
