Depression is a wider term for several types of mood disorders with similar symptoms. Low mood and energy, loss of interest in fun activities, suicidal thoughts, restlessness, and trouble concentrating are all potential signs of a depressive disorder, including persistent or major depression.

Millions of people in the United States struggle with depression, which increases the risk of self-medicating with substances like alcohol, cigarettes, cocaine, or opioids. It is important to get help overcoming a mental health issue like depression before a co-occurring substance abuse problem develops.

Here are five steps to understanding how depression is diagnosed and how that diagnosis may adjust over time.

Step 1: Understand that symptoms can be treated.

Symptoms of depression include:

  • Changes in sleep, appetite, weight, and interest in activities
  • Changes in the ability to concentrate, especially on important tasks
  • Loss of energy
  • Low self-esteem
  • Feeling hopeless or guilty
  • Feeling restless
  • Feeling like something is missing
  • Aches, pains, or exhaustion

Persistence of these symptoms can lead to further mental and emotional struggles, which may compound the original symptoms; however, all forms of depression can be treated, typically with therapy or a combination of therapy and medication. Finding a psychologist, and/or a psychiatrist, is the first step in getting a diagnosis of depression.

Step 2: Undergo a physical exam.

A psychologist or physician may recommend a physical exam before undergoing other evaluations for depression. Some conditions, such as low vitamin D, thyroid disease, Cushing’s disease, Hashimoto’s disease, or another underlying medical condition, could manifest as depression. These conditions are treated differently, with medication as the primary tool instead of therapy.

Step 3: Work with a therapist to test for depression.

There are different types of depression, such as major depressive disorder, seasonal affective disorder, perinatal depression, and psychotic depression, which require different therapeutic approaches. A psychologist will ask their patient a series of questions to better understand the condition from the individual’s experience; the therapist is also likely to use one or more psychological tests to better diagnose the specifics of the condition. Examples of these tests include the Beck Depression Inventory, Hamilton Depression Rating Scale, and the Zung Self-Rating Scale for Depression. A past history of substance abuse, or problems with the liver or kidneys, could also manifest as depression.

The DSM-5 has been updated to help therapists better diagnose depression in their new clients and make more accurate diagnoses. Since symptoms of depression can manifest differently in different people, finding a diagnosis that fits can take time and patience.

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Step 4: Aim for better understanding during therapy sessions.

Intense work in sessions will help both the client and the therapist to better understand the type of depression that is present as well as its underlying causes. Psychologists ask questions during sessions about family history, current circumstances, past trauma, and childhood environment, to better understand the roots of depression and help their client understand how the condition developed. Depression could be rooted in anxiety, other mental illness, substance abuse, past trauma (PTSD), grief, or other issues; finding the root causes will help to refine the diagnosis so the depression can be better treated over time.

Step 5: Work with medication.

Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are prescribed to many people who struggle with depression. The combination of mood-stabilizing medication and ongoing therapy has helped millions of people in the US.

Finding the right medication for depression can take time. If antidepressants do not have the desired effect, it is possible that the original diagnosis of depression was incorrect. The psychologist may shift the diagnosis to another mental health condition, or they may recommend further examination by a physician to look for other underlying causes.