Migraine Patient's Guide to Understanding Depression
As with migraine, the term depression refers to a set of diagnoses which share common symptoms. These diagnoses are collectively called depressive disorders. An accurate diagnosis requires more than just the word depression. There are eight distinct depressive disorders listed in the "Diagnostic and Statistical Manual of Mental Disorders (DSM-5)":
- Disruptive mood dysregulation disorder (DMDD)
- Major depressive disorder (MDD)
- Persistent depressive disorder (formerly called dysthymia)
- Premenstrual dysphoric disorder (PMDD)
- Depressive disorder due to substance use
- Depressive disorder due another medical condition
- Other specified depressive disorder
- Unspecified depressive disorder
Getting an accurate diagnosis
All of these depressive disorders, except DMDD, share the common symptom of depressed mood. Duration, time of onset, and associated symptoms vary with each disorder. Additionally, there are no medical tests available to diagnose a depressive disorder. As with migraine and other headache disorders, depressive disorders are diagnosed based on patient symptoms.
The most common depressive disorder is major depressive disorder. This is a time-limited episode of depressed mood that meets the following criteria:
- Symptoms must be present for at least two weeks and represent a change from previous functioning. Both depressed mood and loss of interest must be present, plus at least three more symptoms to meet the criteria for major depressive disorder.
- Depressed mood most of the day, nearly every day, as indicated by subjective report or observations made by others
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Significant and unintentional weight loss or gain of 5 percent or more within one month, or a marked increase or decrease in appetite nearly every day
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation (restless movement) or retardation (slowed or lack of movement) nearly every day, as observed by others
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day that is not merely self-reproach about being sick
- Diminished ability to think or concentrate or indecisiveness nearly every day
- Recurrent thoughts of death (not a fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide
- Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Not attributable to the physiological effects of a substance (drug abuse or medication) or another medical condition (e.g. hypothyroidism)
- Not better explained by a psychotic disorder
- No history of mania or hypomania.
A diagnosis of major depressive disorder also includes information on severity, remission, and other symptoms specifiers.
Causes of depressive disorders
Unlike the International Classification of Headache Disorders, 3rd Edition (ICHD-3), the DSM-5 does not separate mental illness into primary and secondary disorders. All depressive disorders are listed, regardless of known cause. For example, hypothyroidism is a medical condition known to cause depressive symptoms. If a patient with untreated hypothyroidism presents with a depressed mood, the first step is to treat the underlying medical condition. If depressive mood symptoms disappear with successful treatment, then all depressive disorders are excluded except depressive disorder due to another medical condition.
Migraine itself does not cause depression. There is some evidence that migraine and depression may share common genetic links and they share some overlapping symptoms, too. Like migraine, major depressive disorder, disruptive mood dysregulation disorder, and persistent mood disorder have no known cause.
While any licensed physician can prescribe antidepressants, only a licensed mental health professional is qualified to accurately diagnose a depressive disorder and offer the non-pharmacological treatments necessary for a full recovery.
Similar to migraine, the treatment for a depressive disorder is multifaceted. Medication is only the first step. An effective treatment plan will include antidepressants, cognitive-behavioral therapy, and modification of lifestyle factors such as sleep, exercise, and stress management. Ignoring all three aspects of treatment reduces the chances of recovery and increases the likelihood of recurrent symptoms.
Mental health professionals have met the minimum educational criteria established by their state board of healing arts. Most have obtained a Master’s degree in psychology, counseling, or social work. Some may have also earned a doctorate or medical degree. A state license and malpractice insurance are required to practice psychotherapy or mental health counseling. Most practitioners are members of professional associations (such as the American Psychological Association or the American Counseling Association) and are governed by a code of ethics as well.
Mental health professionals include:
- Social Workers
- Marriage & Family Therapists
More helpful articles:
1 Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C.: American Psychiatric Association; 2013.