Question:
Is it proper to diagnose clinical depression solely because the
patient has fatigue and the cause doesn't show up on any of the tests
the doctor chooses to run? Is it proper to diagnose clinical depression solely because the
patient looks or sounds depressed?
Is it proper to diagnose clinical depression because the patient has
fatigue and the cause doesn't show up on any of the tests the doctor
chooses to run and the patient looks or sounds depressed?
Answer:
When attempting to determine if a patient meets the DSM criteria for
clinical depression, Is it acceptable for the doctor to decide if the
patient has the symptoms listed in the DSM without asking the patient
specific questions about their symptoms?
When attempting to determine if a patient meets the DSM criteria for
clinical depression, Is it acceptable for the doctor to ignore a
patients answers about symptoms if the doctor thinks the patient is in
denial?
Is there such a thing as "Post viral depression"? If there is, does
it have different symptoms than clinical depression? If there is,
does it have different diagnostic criteria than clinical depression?
I get the sense that you are simply looking for confirmation of what you
already know but... Why don't you check out what the DSM says. You can't do an assessment
via mind reading. no but it's also not unusual for a patient not to hear what a doctor is
saying. So, don't attempt to use anything here as ammunition. I have
no clue what your doctor did or did not do. I wouldn't know. It's not something I've heard of. Answer could be
"yes" it could be "no" it could also be that there is such a thing, you
have such a thing and you are also clinically depressed. *Sometimes*
etiology is not an absolutely essential factor in determining treatment. depression may indeed be the cause of some cases of fatigue in people
who don't necessarily meet the DSM criteria for "major depression."
Such "subsyndromal" depression, as it has been called in the
literature, has substantial effects on quality of life and somatic
symptoms. I prefer to use a depression symptom checklist
questionnaire for my office patients, but sometimes an empiric trial
of an antidepressant can bring surprising results. Depression related
to previous infection, or even ongoing acute illness, such as coronary
disease or cancer, needs to be identified and treated. Medications
are useful for those of us who aren't psychologists/therapists or with
patients who refuse to see them because they don't think the problem
is "emotional." It isn't--it's probably chemical. The DSM is a tool
that is elegant, but in truth most primary care providers don't use
their classification schemata. IMHO, H2 I agree with Mark except on the issue of the weight of subjective reporting
vs observation by others. . It is unclear to me which weighs more heavily in
the diagnostic decision. There are a number of factors involved in being
diagnosed depressed and at least a certain number must be true or present to
make the diagnosis. Any criterion alone is insufficient. However, that does
not mean the doctor had to seek your verbal response for each criterion. You
may have answered some questions without them being asked, and the criteria
allows for observation of others and is not necessarily dependent on the
patient's subjective opinion. My answer to some of Daniel's questions
differs from below only slightly. I would add that, according to the DSM IV,
the existence of depressed mood can be based on subjective report OR
OBSERVATION made by others. Same is true for markedly diminished interest in
activities, and diminished ability to think or concentrate. It would bother
me if my doctor thought I was in denial; I might even feel disrepected. On
the otherhand, I'd think long and hard before deciding he was wrong! What if
I was in denial! However, if there is an underlying medical cause for the symptoms it would
be inaccurate to use the label depression. If fatigue is the presenting
complaint I wonder if you have ruled out a sleep disoreder such as sleep
apnea, or the syndrome FMS, or chronic fatigue. There may be other less
obvious things to rule out as well, although I've exhausted my list! The
ICD(?) physicians use has plenty of stuff not in DSMIV and I agree that
the post viral thing could exist. Interesting. Peeked my curiousity. Did you
recently have a virus?
This concern about the accuracy pf the label relates to concerns expressed
by many fibromyalgia sufferers. Because there is not a concrete diagnostic
test to diagnose FMS, and sometimes the primary presenting concern at first
is fatigue, people at first are labeled depressed. It seems some of them do
not want the label and do not think it is accurate. Sometimes FMS sufferers
also BECOME depressed as they find it difficult to adjust to the loss of
their old lifestyle. Still I hear sufferers saying they do not want to be
treated primarily as depressed in part because of the underlying message
that their other FMS symptoms are "in their heads". There is also a stigma
to "depression".
