Depression Diagnosis: Understanding the Criteria and Process

Cindy Wilson Thumbby Cindy Wilson
BS, Dietetics and Nutrition

We all feel sad and ‘low’ from time to time, and that’s not a bad thing. But for some people, depressed mood is constant, and it affects their ability to perform different tasks. A recent Gallup poll shows that as many as 29 percent of Americans have received a diagnosis of depression. But how do mental health professionals diagnose some people with depression but not others? For that, it’s important to look at the process you must go through and the criteria you must meet to get a diagnosis. Let’s look at how mental health professionals diagnose people with depression and the criteria they use. 

depression diagnosis understanding the criteria and process

What is Major Depressive Disorder? 

When medical professionals say ‘depression,’ it’s likely that they’re referring to major depressive disorder. It falls within the category of depressive disorders, and it’s characterized by low mood, a lack of interest, fatigue, a change in appetite, and other symptoms. These symptoms occur for at least 2 weeks and cause impairment in various areas of your life. 

Diagnostic Process

Before you can receive appropriate depressive disorder treatment, you need to receive a diagnosis. This involves going through a detailed process to rule out any other causes and ensure that you receive the correct diagnosis. 

Medical Evaluation 

The first step involves undergoing a physical exam. During the exam, a physician will ask questions about your medical history and whether certain conditions run in the family. They’ll also ask for permission to look at your medical history to see if you’ve had any major illnesses or surgical procedures. 

Bloodwork and Other Tests

Your doctor may also require some lab tests, such as a complete blood count and a thyroid test. This is done to check your blood’s alcohol levels. Blood tests determine whether you take any illicit substances or medications that could potentially cause your symptoms. 

It also helps understand whether you have a nutritional deficiency or other medical condition that could be causing your illness. Meanwhile, thyroid tests can determine if the gland is functioning properly.  

Psychiatric Assessment 

Here, a mental health professional will ask how you’re feeling, what you’re thinking about, and how you usually behave. As part of the assessment, you may have to fill out a questionnaire that provides details of your symptoms. 

Your mental health practitioner will use screening instruments to measure the severity of your symptoms. Some of the inventories recommended by the American Psychological Association include: 

  • The Beck Depression Inventory (BDI): It has 21 questions with multiple-choice responses. It’s a self-report questionnaire that can determine the severity of your depressive feelings. 
  • Center for Epidemiologic Studies Depression Scale (CES-D): This is used to evaluate your feelings, behavior, and overall outlook from last week.  
  • Hamilton Depression Rating Scale (HAM-D): Your mental health practitioner may use this multiple-choice scale to rate the severity of your depressive symptoms. 

Comparison With Diagnostic Criteria

After recording your symptoms and their degree of intensity, your psychiatrist will compare them with the diagnostic criteria. 

Diagnostic Criteria

When diagnosing you with major depressive disorder, psychiatrists refer to the fifth edition of the APA’s Diagnostic Statistical Manual. It’s listed under the category of depressive disorder and is as follows: 

  1. You should experience at least five of the following symptoms within the same 2-week period. These symptoms should indicate a difference in regular functioning.
  1. Low mood for the majority of the day and almost every day. This can be indicated through a self-report or an observation from others. 
  2. You should show low interest or pleasure in almost all the activities you engage in. This should happen nearly every day and can be recorded through a self-report or observation.
  3. Experiencing weight gain or weight loss without the intention to go on a diet. Or a change in appetite nearly every day that causes a change in more than 5 percent of body weight in a month. 
  4. Major shifts in sleeping patterns. You’re unable to sleep (insomnia) or sleep too much (hypersomnia).
  5. Psychomotor retardation is characterized by slowed reactions, sluggish movements, and poor hand-eye coordination, as observed by others. 
  6. Feeling fatigued every day. 
  7. Having excessive guilt (the source of this feeling can be delusions) and feelings of worthlessness almost every day. 
  8. Lack of concentration and poor decision-making abilities, as reported through a subjective account or observation. 
  9. Persistent thoughts of death and consistent suicidal ideation with or without a specific plan to commit suicide. 

Out of the five symptoms you experience, at least one should be low mood or loss of pleasure. 

  1. Anyone can experience the above-mentioned symptoms from time to time. However, Criteria B requires that the symptoms lead to clinically significant distress or impairment in important areas of functioning, like in relationships, at work, or when taking care of yourself.
  2. Your depressive episode shouldn’t be the result of another medical condition or the physiological effects of a substance. 
  3. The symptoms you experience during a major depressive episode (criteria A to C) shouldn’t be better explained by schizophrenia, delusional disorder, schizoaffective disorder, or any other psychotic disorder. 
  4. You should not have experienced a manic or hypomanic episode. (This doesn’t apply if you experienced manic-like symptoms due to the physiological effects of a substance)

Types of Depression 

Besides depressive episodes, your illness may include specific features. The DSM-5 lists specifiers to help mental health professionals paint a clearer picture of your condition. They are:

  • Anxious distress: you experience worry or restlessness. 
  • Mixed features: you experience depression and mania simultaneously.  
  • Melancholic features: you have severe depression and no response to activities that previously brought pleasure. 
  • Atypical features: your mood improves in response to positive events, and you experience weight gain, hypersomnia, heavy feeling in your arms or legs, and sensitivity to rejection.
  • Catatonia: when you show motor activity such as inflexible posture or uncontrollable movement. 
  • Peripartum onset: the depression occurs during pregnancy or in the weeks after delivery. 
  • Seasonal pattern: your depression is affected by changes in seasons.  

Understanding the specific features of your depression can help your mental health professional determine an appropriate treatment plan.

About Author

Cindy Wilson Thumb
BS, Nutrition & Food Science | Connect with on LinkedIn
Cindy Wilson

Hello, I am Cindy, and this a website where I inspect everything related to nutrition and a healthy lifestyle. I have a BS in Dietetics and Nutrition (Kansas State University) and have completed a dozen specialty courses related to nutrition, biochemistry, and food science. I am open to learning more, but foremost I would like to share all my knowledge with you.

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