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Diagnosing & Treating Depression

By Hilary A. Sojdak, APRN, Director of Clinical Services at PASWFL

Diagnosing & Treating DepressionThe holiday season is supposed to be a time of optimism and cheer; however, many people struggle with a variety of distressing psychological symptoms that impede on the ability to find peace and happiness each year. Feelings of sadness, despair, or overwhelming burden may result in a temporary inability to function and often are further exacerbated or masqueraded by other medical or psychiatric co-morbidities, and illnesses.

As mental health clinicians, it is paramount that we conduct a thorough account of current symptoms, along with history to arrive at an accurate diagnosis and subsequent effective treatment plan that encompasses the physiological, psychological and social needs of the individual. The term “depression” has multiple faces, and signs and symptoms may present themselves to varying degrees on a spectrum.

This complete psychiatric assessment that includes details of the current symptoms, and comprehensive account of history becomes the foundation for the potential of successful management or alleviation of symptoms.

To enable the clinician to decide amongst multiple differentials versus recognizing episodic sadness as a part of the typical range of human emotions, consideration must not only be given to one’s current range of symptoms but also details of the past psychiatric, medical, social, traumatic, cultural, occupational, educational and alcohol or drug use history.

The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) “The qualifiers for a diagnosis of “depression”:

Five or more of the following symptoms have been present and documented during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

1) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful)

2) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation)

3) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day

4) Insomnia or hypersomnia nearly every day

5) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

6) Fatigue or loss of energy nearly every day

7) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

8) Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

Experiences of various levels of anxiety, seasonal variation, mood irritability or agitation and feelings of being “keyed up” or restlessness may be present. This mixture of potential symptoms can make it difficulty to distinguish an episodic depression versus alternatives and qualifying subsets.

Psychiatric differentials include bipolar disorder, a mood disorder in which the individual experiences cyclical mood highs (mania) and lows (depression), post-traumatic stress related disorders (PTSD), and seasonal affective disorder (SAD). In addition, one may be experiencing medical or physiological symptoms related to illnesses such as:
. Dementia
. Delirium
. Hypothyroidism
. Parkinson’s disease
. Stroke
. Connective tissue diseases
. Childbirth (post-partum) or menstrual related
mood disorders (premenstrual dysphoric disorder)
. Traumatic Brain Injury

Social factors include things such as financial stress, social isolation and distance from other family or close friends, and consideration must be given to cultural norms or surroundings, and geographic location.

Referring for appropriate treatment of co-occurring medical illnesses, initiating treatment or referral for substance abuse, and stabilizing co-morbid psychiatric illness is a vital first step. Exploring the availability of community social supports with the individual and assisting to gain access to appropriate grief counseling or other forms of psychotherapy, while may be more time consuming for the clinician, ultimately can create profound therapeutic responses that substantiate the course of time. Initiating or altering prescription psychotropic medications, may be of sound clinical reasoning and used in conjunction with psychotherapy. Newer treatments options, such as transcranial magnetic therapy, theta burst stimulation, or ketamine infusion options may be available either used on or off-label, or older treatments like shock therapy in select cases, may be considered and discussed with patients and families along with proper self-care with diet, nutrition, and exercise.

Euthymia, or the absence of depression, can be safely, efficiently and effectively reached and maintained through careful assessment, intervention and monitoring by the mental health clinician.

6804 Porto Fino Cir #1, Fort Myers, FL 33912
Office: 239-332-4700 | TMS & Ketamine: 888-491-4171

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