How it is determined that patients have a particular type of depression? The classification of depression is done on the basis of DSM guidelines issued by American Psychiatric Association.

DSM is an abbreviated form of Diagnostic and Statistical Manual of Mental Disorders. It is used by psychiatrists for diagnosing the mental conditions. The DSM guidelines are also used by insurance companies for providing reimbursement for treatment.

Diagnostic criteria for Major Depression

For major depression, a patient should satisfy following two conditions.

  • Patient must meet five or more of the following symptoms for more than two weeks period
  • Symptom must be either depressed mood or a lack of interest

Symptoms for Major Depression

  • Depressed mood during entire length of day almost daily
  • Feeling of sadness, or tearful in children and adolescents
  • Depressed mood appear as a sign of constant irritability
  • Diminished interest in doing all activities throughout the day almost daily
  • Considerable weight loss when not dieting or even weight gain
  • Increase/Decrease in appetite daily
  • Sleep disturbances like Insomnia/increased sleeping hours daily
  • Restlessness or slowed behaviour
  • Lack of energy or fatigue almost daily
  • Feelings of worthlessness/excessive guilt almost daily
  • Difficulty in making decisions
  • Difficulty in concentrating
  • Suicidal thoughts almost daily

Moreover, there are certain features that are peculiar to major depressions.

  • Symptoms do not highlight mixed episode such as simultaneous mania and depression as in bipolar disorder.
  • Severity of symptoms interferes with normal activities at school, work, or social activities.
  • Symptoms do not result due to direct consequences of taking medication, drug abuse or any associated medical condition like hypothyroidism.
  • Symptoms do not result due to any temporary life event such as sadness after the death of a loved one.

Diagnostic Criteria of Bipolar Disorder

There are basically two subtypes of bipolar disorder including Bipolar I disorder and Bipolar II disorder.

Bipolar I disorder: Minimum one manic episode + with or without major depressive episodes

Bipolar II disorder: Minimum one episode of major depression + at least one hypomanic episode

Diagnostic Criteria of Dysthymia

The diagnostic criteria of Dysthymia involve the following.

  • Symptoms must have lasted for a longer period of time (two years of more)
  • Symptoms must be less severe than symptoms of major depression
  • Symptoms should not result due to substance abuse or any medical condition
  • Symptoms should cause clinically significant distress
  • Symptoms should cause impairment in social and occupational areas of your life

Diagnostic Criteria of Postpartum depression

It is a common type of depression that starts four to eight weeks after delivery and may continue for months.

  • Depressed mood during entire length of day almost daily
  • Feeling of sadness, or tearful in children and adolescents
  • Depressed mood appear as a sign of constant irritability
  • Diminished interest in doing all activities throughout the day almost daily
  • Considerable weight loss when not dieting or even weight gain
  • Increase/Decrease in appetite daily
  • Sleep disturbances like Insomnia/increased sleeping hours daily
  • Restlessness or slowed behaviour
  • Lack of energy or fatigue almost daily
  • Suicidal thoughts

Depression is a complex disease that involves imbalance of various chemicals and their interactions. As such there is no single chemical held responsible for causing depression.

Moreover, there is no exact cause known for depression and thus, there is no exact diagnostic laboratory test for identifying depression.

A psychiatrist recommends the diagnostic tests on the basis of various factors.

  • Age of the patient
  • Physical symptoms of the patient
  • Medical history of the patient
  • Fewer Tests for individuals who have less symptoms and are younger than 40
  • More tests for individuals who have many symptoms and are older than 50

Even though the diagnostic tests do not help much with root cause of depression, they can help in evaluating the reasons of depression.

The various laboratory tests help in identifying the presence of any medical problems that may result in depression. In fact, diagnostic tests make up an important part of overall evaluation of depression.

Common Laboratory tests for evaluating Depression

  • Blood tests for TSH and thyroxin levels for excluding hypothyroidism
  • Basic electrolytes and serum calcium for ruling out metabolic disturbances
  • Full blood count including ESR for ruling out a systemic infection
  • Adverse affective reactions for alcohol misuse
  • Evaluation of Testosterone levels for diagnosing hypogonadism
  • Subjective cognitive complaints in older depressed people

All these tests are not meant for depression itself; however they assist in ruling out various medical problems that underlies depression. Thus, evaluation of the results of these tests helps in determining the proper treatment for you.

Blood Tests

A blood test provides valuable information regarding the functioning of various glands of the body.

Thyroid Gland: The functioning of the thyroid gland can be checked by measuring the levels of certain hormones in the blood.

Low levels of thyroid hormone (hypothyroidism) present the symptoms similar to depression. Thus,

if patient is suffering from hypothyroidism, the symptoms of depression can be treated by thyroid disorder.

Fatigue or Weight Loss: In case patient complains of fatigue or weight loss, psychiatrists may recommend complete blood count and chemistry profile.

Anaemia: Patients suffering from anaemia have low count of red blood cells (RBC). It can be evident from the results of complete blood count that measures the number of RBC and WBC in blood.

Infection in Immune System: The presence of very low or high numbers of WBC in blood count may indicate the presence of infection or problem with immune system.

Kidney and Liver Disorders: A chemical profile of the blood helps in evaluating the function of your kidney and liver. It identifies the irregularities in the concentration of various substances (sugar and cholesterol) in body.

X-Rays

A chest X-ray is recommended by a psychiatrist if he/she suspects a specific problem related to lung or heart disease. Moreover, X-rays or scans also help in evaluating different kinds of cancer.

Other Imaging Techniques

Computed tomography (CT) and Magnetic Resonance Imaging (MRI) are used for evaluating neurological illnesses. Your psychiatrist may suspect a neurological illness by evaluating the symptoms of physical examination.

In severe cases, an electroencephalogram is performed for diagnosing a seizure disorder and offers useful information about functioning of the brain.

Initial diagnosis of depression begins with physical examination of the patient. Even a primary care

doctor can complete the initial evaluation of the depression and prescribe antidepressant to the patient.

A Physical exam used commonly by psychiatrists for ruling out any physical cause for depression.

During the physical exam, a psychiatrist primarily focuses on nervous and hormonal systems.

Moreover, the psychiatrist will try to look for any major diseases that may present the symptoms of clinical depression.

Common medical conditions associated with depressive symptoms

  • Hypothyroidism caused by an underactive thyroid gland
  • Hyperthyroidism caused by an overactive thyroid
  • Cushing’s disease caused by disorder of the adrenal gland.
  • Central nervous system tumours
  • Head trauma
  • Multiple Sclerosis
  • Stroke
  • Syphilis
  • Cancers

Apart from various medical conditions there are certain medications that contribute to the depression symptoms.

  • Corticosteroid medications such as prednisone (recommended in rheumatoid arthritis or asthma)
  • Illegal steroids and amphetamines
  • Over-the-counter appetite suppressants

What happens during a Physical Examination?

Get ready with the answers to all questions your doctor might ask you during physical examination.

You should inform your doctor about all the depression symptoms and any other physical symptoms.

Common questions asked by doctor

  • What are the various symptoms felt by you?
  • How severe are these symptoms?
  • What are the triggers of these symptoms?
  • Any particular timings or frequency of the symptoms?
  • What relieves the symptoms?
  • How long your symptoms have lasted?
  • Any medical illness you have had?
  • What are the various drugs or medications you are taking?
  • Any family history of depression?
  • Your hobbies or general life style?

As the question/answer session might take time, you may forget any useful information said by doctor or also miss out in providing any important detail. Thus, it is better idea to write down all the important points on a piece of paper and bring it with you while coming to see your doctor.

Apart from evaluating the symptoms and asking various questions your doctor might examines the various parts of your body to rule out the presence of any other disease that may cause depression symptoms.

Nervous System Examination:  The symptoms of psychiatric disorders and neurological disorders are usually common; therefore doctors usually examine the nervous system of patients.

Your doctor may test the functioning of your nervous system, including assessment of movement, reflexes and muscle strength. Your doctor will check if you have any problems with walking or muscle weakness.

Thyroid Disorder Examination: Your doctor may also examine your neck to experience if thyroid gland is enlarged as thyroid disorders may lead to various mood problems.

Circulatory System Exam: Your doctor may also check your pulse and listen to your heart beats. In some cases, doctors may also check for swelling in your feet because depression may also result from underlying heart problems.

Rectal examination: As anaemia may cause loss of energy, your doctor may perform a rectal exam to evaluating any gastrointestinal bleeding.

Although most of these examinations are not directly related to the depression, however identifying and treating a physical problem may relieves the depression.

Are you feeling depressed and planning to visit your doctor? If yes then you should know about

various diagnostic tests that your doctor might recommend.

In fact, not every test recommended by your doctor is a depression test. Most of the tests are used for ruling out other serious medical conditions that cause symptoms similar to that of depression.Generally, a psychiatrist will perform a physical exam and ask the patient to conduct specific lab tests for ruling out any other cause of depression symptoms.

In case your depression symptoms are due to other serious disease, the treatment of that disease will alleviate the symptoms of depression.

Physical Exam

A Physical exam used commonly by psychiatrists for ruling out any physical cause for depression. During the physical exam, a psychiatrist primarily focuses on nervous and hormonal systems.

Moreover, the psychiatrist will try to look for any major diseases that may present the symptoms of clinical depression.

Common medical conditions that may be associated with depressive symptoms are as follows.

  • Hypothyroidism caused by an underactive thyroid gland
  • Hyperthyroidism caused by an overactive thyroid
  • Cushing’s disease caused by disorder of the adrenal gland.
  • Central nervous system tumours
  • Head trauma
  • Multiple Sclerosis
  • Stroke
  • Syphilis
  • Cancers

Apart from various medical conditions there are certain medications that contribute to the depression symptoms.

  • Corticosteroid medications such as prednisone (recommended in rheumatoid arthritis or asthma)
  • Illegal steroids and amphetamines
  • Over-the-counter appetite suppressants

Laboratory Tests

In most of the cases, your psychiatrist may ask you to conduct various lab tests for ruling out the other diagnoses.

Blood tests are used for checking anaemia, thyroid, hormone, and calcium levels.

  • Blood tests for TSH and thyroxin levels for excluding hypothyroidism
  • Basic electrolytes and serum calcium for ruling out metabolic disturbances
  • Full blood count including ESR for ruling out a systemic infection
  • Adverse affective reactions for alcohol misuse
  • Evaluation of Testosterone levels for diagnosing hypogonadism
  • Subjective cognitive complaints in older depressed people

Other Testing Methods

In some cases, your psychiatrist may recommend other tests as a part of physical exam.

  • Blood tests for checking electrolytes, liver function, and kidney function
  • CT scan or MRI of the brain for ruling serious brain diseases like brain tumour
  • Electrocardiogram (ECG) for diagnosing heart problems
  • Electroencephalogram (EEG) for recording electrical activity of the brain

Screening Tests for Depression

There are certain screening tests that are used for diagnosing depression. Your psychiatrist may ask you specific questions as a part of screening test for depression.

You may be asked to complete some questionnaires as a part of the diagnosing procedure. The screening tests assist the doctors in better analysis of the mood and symptoms of patient.

Depression screening instruments

The screening instruments help in measuring the severity of depression in patients.

  • Beck Depression Inventory (BDI): It comprises of 21 multiple-choice questions to be answered by patient. A self-report that is generated is used for measuring the severity of depression symptoms.
  • Zung Self-Rating Depression Scale: It is a short survey to be completed by patient and results are used for measuring the level of depression that may range from normal to severely depressed.
  • Center for Epidemiologic Studies-Depression Scale (CES-D): It is a screening instrument that allows patients to assess their mood and behaviour.
  • Hamilton Rating Scale for Depression (HRSD): It is a multiple choice questionnaire to be answered by patients and it used for measuring the severity of a patient’s depression.

Thoracentesis or Pleural Fluid Sampling test is performed in severe cases of Pneumonia and other diseases that cause fluid accumulation in pleural cavity.

In case, you are wondering about Thoracentesis and why it is performed; let’s us understand the scenario where Pleural Fluid Sampling procedure is used.

In some severe cases of pneumonial infection/other diseases, the fluids gets accumulated in the space present between the lungs and the rib cage or diaphragm. This process of fluid collection is known as pleural effusion. It is usually detected on a Chest X-ray.

The sample of the fluid collected by pleural effusion is taken for analysis by the doctors. It is done for detecting the presence of germs in the fluid that had caused the infection.

Preparation for Thoracentesis

                     Patient may be shifted to a hospital for the procedure or it can be performed in the doctor’s clinic depending upon his/her medical condition.

                     Before the procedure, patient may be asked to sign a consent form that permits your doctor to perform this test.

                     Patient will be asked to undertake a chest x-ray or an ultrasound test prior to the procedure.

                     Doctor should be informed about any allergic reaction to the numbing medicine like lidocaine.

                     Doctor should be informed if patient is taking any medications such as aspirin, NSAID, or other drugs that affect blood clotting.

                     Patient may be asked to stop or adjust the dosage of various medications he/she is taking.

Thoracentesis Procedure

                     During the process, patient is asked to wear a hospital gown and made to sit on a bed. Patient is made to lean forward against the pillows.

                     Doctor uses stethoscope for listening to lungs sounds and slowly taps on the back for judging the amount of fluid collected in the pleural cavity.

                     Doctor applies the soap for disinfecting an area of skin and a small needle is applied for numbing a small area of skin between two lower ribs with the numbing medicine.

                     Doctor inserts a needle on an empty syringe into the fluid pocket and minor pressure is applied.

                     The syringe is used for collecting the fluid or it may be collected into bag by using plastic tubing.

                     Patient is instructed to hum out loud and avoid taking deep breath. The fluid is removed within 15 minutes and bandage is placed on back after the procedure.

Risks of Thoracentesis

Thoracentesis is usually a safe procedure with very less or no complications. However, there are few risks associated with the process.

                     Air leak may occur due to needle piercing the lung accidently. It is usually detected on X –ray and requires patient to spend few days in the hospital.

                     Infection or bleeding into the fluid space

                     Rapid pressure changes in your lung in case a large amount of fluid is removed

                     Pulmonary oedema due to leakage of fluids from bloodstream into the lungs

                     Shortness of breath

A Sputum evaluation test is recommended by the doctor in severe cases of Pneumonia. It is a very simple test and you need not put much effort in it. It is not only painless but also non invasive.

This test involves collection of sample of sputum from the patient and its subsequent analysis. It helps the doctor in detecting the type of germ that caused the infection.

Preparation for the test

There is no special preparation needed for the test. However, you may be asked to drink plenty of fluids the evening before the test. It helps in producing the sample of the sputum.

Sputum Evaluation Procedure

Your doctor may recommend you to get the sputum evaluation test done. It is indicated in cases where a patient is suspected to have pneumonia.

                    You will be asked to produce sample of your sputum by coughing out of your lungs.

                    This sputum is collected and sent to the doctor.

                    The doctor examines the collected sputum for identifying the kind of infectious agent like bacteria, virus, etc that had caused the infection.

Things to take care during the test

You should ensure that the cough needs to come from deep insure the lungs.

In case, your cough is too dry, you will be asked to breathe in a saltwater mist via a tube/mask. It helps in producing good phlegm sample by making you cough deeply.

Risks of Sputum evaluation test

The sputum evaluation test is a very safe procedure and there is no risk involved in the procedure.

After the procedure

Once the sputum test is over and sample is collected, it is sent to the technician. The technician stains the sputum sample and observes it closely using a microscope. The results of the stain test are available on the day of the test.

In some cases, doctor may ask the technician to grow the sputum culture. In this process, sputum is incubated for accelerating the growth of bacteria or any other germs present in it. These are used for further tests. The sputum culture needs several days to complete.

You would be amazed to learn that doctors remove a very small piece of lung for examination by performing lung needle biopsy. A lung needle biopsy is performed in severe complicated cases associated with lung and its tissues.

Doctors perform the biopsy after detecting the abnormalities on chest x-ray or CT scan.

The lung biopsy performed through the chest wall, is known as transthoracic lung biopsy.

Indications for Lung needle biopsy

                    Abnormal condition surrounding the lungs

                    Infections inside the lungs

                    Severe infection on the chest wall

                    To rule out the presence of cancer

Preparation for Lung needle biopsy

Patient should follow the below mentioned guidelines before lung needle biopsy procedure.

                    Patient is asked to not eat 6 – 12 hours prior to the procedure.

                    Patient should avoid certain medications like aspirin, NSAIDs or blood thinners, etc; few weeks before the procedure. However one should discuss with doctor before changing or adjusting the doses of these medications.

                    Doctors usually perform a chest x-ray or chest CT scan before the procedure.

                    Patient is administered with mild sedative for relaxation prior to biopsy.

                    Patient is asked to sign a consent form before the procedure.

                    Patient is asked to avoid coughing and remain as still as possible during the biopsy.

Lung needle biopsy Procedure

                    The exact spot for the biopsy is determined by using a chest x-ray or chest CT scan.

                    Patient is made to sit with his/her arms resting forward on a table. Patient is asked to avoid any coughing and remain still during the biopsy.

                    The small patch of the skin scrubbed and patient is asked to hold his/her breath. Doctor injects the local pain-killing medicine for numbing the area.

                    Doctor makes a small cut of about 0.12 inches into the skin and inserts the biopsy needle into the lung tissue. It is followed by removing a small piece of tissue with the needle.

                    The removed lung tissue is sent to laboratory for further examination. After the procedure, the bleeding is stopped by exerting pressure on the site.

                    Once the bleeding is stopped, a bandage is applied on the operated region. Patient is sent for chest X- ray immediately after the biopsy.

                    The time duration for the entire procedure vary from 30 – 60 minutes. The sample obtained from lung needle biopsy is sent for Lab analysis which takes few days to get completed.

Lung needle biopsy Results

The results of the lung needle biopsy are obtained after the analysis of obtained lung tissues is completed.

Normal Results indicate the presence of normal tissues and absence of any bacteria, viruses, or fungi.

Abnormal Results indicate the presence of following infections.

                    Bacterial or viral infection

                    Fungal lung infection

                    Cancerous cells

                    Pneumonia

Lung needle biopsy Risks

                    Occurrence of collapsed lung called as pneumothorax

                    Higher risk in case of certain lung diseases like emphysema

                    Air leakage from the lung that gets trapped in the chest

                    Risk of excessive bleeding (haemorrhage)

 

How is Pneumonia Diagnosed?

If you have symptoms of Pneumonia, you should visit your doctor at your earliest convenience. The doctor will diagnose pneumonia on the basis of signs & symptoms, Lab Tests results, physical exam, chest X rays, etc.

The symptoms of Pneumonia are similar to that of influenza or cold. Thus, patient may not realize the presence of pneumonia until the symptoms get worsened.

Let’s briefly discuss the various ways used for diagnosis of Pneumonia.

Studying Signs and Symptoms

The doctor will ask various questions to the patient to study signs and symptoms of Pneumonia. The questions may range from habits, hobbies of the patient to its past medical history to any medication he/she is taking.

Physical Exam

The doctor will use the stethoscope for performing the physical exam of the lungs.

The individuals infected with pneumonia will produce crackling, wheezing and rumbling sounds in the lungs during inhalation.

The absence of regular sounds in cheat areas may point to the infection caused by pneumonia.

Laboratory Tests

After the physical examination, the doctor may ask the patient to conduct certain laboratory tests. These are done for confirming the presence of pneumonial infection.

Lab Tests recommended by doctor are as follows:

Chest X-Ray: A chest X-ray is widely used diagnostic test for diagnosing pneumonia. It is performed to visualise the various structures situated inside the chest including lungs, heart and blood vessels.

Only drawback of the chest X-ray is that it does not identifies the infectious agent that had caused pneumonia.

Blood Tests: A Blood test requires you to provide a sample of blood which is sent for analysis. The blood report includes the complete blood count (CBC) including number of white blood cells.

Doctor will look for the number of WBC in your blood to confirm the presence of bacterial infection.

In some cases, doctor may ask for a blood culture to identify the germs in the bloodstream.

Diagnostic Tests for Severe Cases

Pneumonia may affect anyone, however it is more severe in cases of infants, children, hospitalised individuals, older adults (65 or above), and individuals with associated complications.

The following diagnostic tests are performed for severe cases of Pneumonia.

Sputum test: This test involves collection of sample of sputum from the patient and its subsequent analysis. It helps the doctor in detecting the type of germ that caused the infection.

Chest computed tomography (CT) scan: In some cases, a chest CT scan is performed to see the accurate and detailed images of internal structure of lungs. It is more advanced and elaborative than chest X-ray test.

Pleural fluid culture (thoracentesis): In thoracentesis procedure, a sample of fluid is collected from the pleural space between the lungs and chest cavity. This sample of pleural fluid is analysed for the presence of specific type of germ responsible for infection.

Bronchoscopy: It is performed for viewing the internal details of lungs’ airways. It is recommended in cases where the individual is hospitalised and does not respond to treatment with antibiotics.

 

A chest X-ray is one of the simplest tests to be performed. It is not only painless but also non invasive. Your doctor will recommend chest X-ray to get detailed images of internal structures such as lungs, heart and blood vessels.

A chest X-ray assists in the diagnosis of conditions like pneumonia, chronic cough, chest pain,

shortness of breath, etc.

Preparation for Chest X Ray

You may follow the below mentioned points in order to prepare for Chest X ray.

                     Wear loose clothes like T-Shirt that can be easily taken off as you will be asked to undress from the waist up and wear a gown.

                     Avoid wearing metallic objects such as jewellery, eye glasses, belts, etc; while going for the chest X-ray. It is required so that there is no interference between metals and X-ray Image.

                     Inform the X-ray technician about any body piercings done by you on your chest.

                     Inform the doctor if you are pregnant as X ray test are usually avoided during pregnancy.

Chest X Ray Procedure

A Chest X ray procedure is performed by an X-ray technician and total time duration of the test is usually 15 minutes.

                     You will be taken to the X-ray room, and asked to undress from the waist up and wear gown.

                     You may be asked to stand, sit, or lie for the chest x ray as directed by your doctor. You need not worry as the technician will assist in maintaining correct position.

                     You will be covered with heavy lead apron for protecting your other body parts from radiation.

                     The X-ray technician will operate the X-ray machine and takes two view of the chest including back view and side view.

                     Back view: You need to sit or stand for resting your chest against the image plate. The x-ray tube is placed behind you.

                     Side view: You need to stand side ways and keep your arms above your head.

                     In case, you will be asked to lie down, you will need to lie down on table with X-ray tube located over the table.

                     During the procedure of taking X-rays images; you are required to remain still and hold your breath for a few seconds.

                     After the images are taken, they are checked by X-ray technician for their quality. The procedure is repeated if the quality of images is not good enough.

·         After the procedure

                     You may go home after the test and resume your normal activities. A radiologist will analyze the X-rays and prepare a report.

                     You may obtain your reports and show them to your doctor. Your doctor will observe the X-rays images and discuss the results with you.

Risks of Chest X Ray

Although the amount of radiation in Chest X-ray test is very small, it carries few risks.

During the procedure, patient is provided with a lead apron for protecting certain body parts from the harmful effects of radiation.