Why Your Doctor May Have Overlooked Your Depression

Medical Reviewer

You feel dreadful. It's getting worse. You can't focus, sleep properly and your appetite has changed. You feel moody, restless, tearful and downright miserable. Everyone, and even your dog, seems to sense you're depressed, so how is it your doctor has passed it off as a viral infection? Diagnosing depression isn't as easy as you might think and it's as much a problem for the doctor as it is the patient. In this Sharepost I'm going to touch on just a few of the issues that might explain why your diagnosis of depression may be overlooked or delayed.

Let me first make a qualifying statement. If you have a history of depression then the issues I outlined in the first paragraph probably won't apply to you. In fact a possible problem in your case is that those fairly general physical symptoms that may denote an illness are mistakenly viewed as symptoms of depression. This is much more likely if you don't present with a fever or rash or some other overt physical signs. However, the focus of this post is more towards people who have no previous history of depression.

From the perspective of the patient it isn't at all uncommon for them to miss the depression target completely. A lot of the symptoms of depression feel quite physical in nature and even if they aren't we appear hard-wired to look for explanations for the way we feel in a physical way. Actually this is sensible. Anyone who has experienced, say, flu or a viral infection will know how it drags your motivation and mood into your boots. It stands to reason that if you can't identify an external cause for changes in your emotional state, you'll start to look inside yourself.

So, you get yourself off for a consultation. You wait and eventually you get your 10 minutes or so. You tell the doctor how you feel. They take your blood pressure, ask whether you've been feverish, ask how long you've felt like this, how it's affecting your work and daily life. It sounds like they are on to something. Then they state the obvious - something like, 'you do sound a little run down,' or, 'when did you last take a break?' Maybe they take a blood sample, and before you know it you're thanking them and heading for home.

At home you reflect on what's happened. Maybe you're relieved that your symptoms weren't identified as a sign of some terrible disease? Maybe you feel a little better because you've managed to see a health professional and say things previously unsaid? Or maybe you feel frustrated because the very thing you were conscious of, your mood, appears to have been overlooked and you feel no better.

Let's unpack some of the possibilities, starting with the doctor. A possibility is that your doctor has relatively little experience recognizing and treating depression. Unless they are very new into the job this is unlikely, as well over a quarter of the patients seeing their family doctor will suffer from depression, anxiety or both. Despite professional training the role of personal beliefs could still have some bearing in the way your symptoms have been perceived or acknowledged.

Now we factor the patient into the equation. With no prior history of depression they have presented a list of fairly general symptoms that could relate as much to depression as to some viral condition, or other possibilities like thyroid deficiency, hormonal upsets, iron deficiencies and so on. Quite rightly, the doctor has taken a blood sample and sent it for analysis. This will help to rule out possible physical reasons for symptoms of depression. Perhaps where the system sometimes fails is the assumption that in finding a physical cause, mood will lift. Well it may, but then again what's stopping a patient with depression also having a physical problem? In such cases the depressive symptoms may be dismissed as a form of collateral damage rather than as symptoms in their own right that need treating.

There are different ways for a doctor to screen for depression but professional judgment is still a potent force that can work for or against the patient. However, the use of standardized questionnaire techniques is more common now. The Hamilton Rating Scale for Depression (HRSD), for example, is said to be sensitive to changes in the severity of depression. This means once a diagnosis of depression is made and treatment begins, the HRSD can help point to the effectiveness if therapy.

Tools such as this and the popular Beck Depression Inventory, which reflects the severity of depression, all have their place. Ultimately their use comes down partly to the inclination of the doctor to use them and the messages given to the doctor by the patient that may persuade them. Some doctors have a finely tuned sense towards mental illness whilst others don't appear to, or have not as yet developed the skills. As patients, we have no natural internal mechanism that says, 'this is depression', so perhaps it isn't so surprising that the physical symptoms appear to take priority. After all, many people contact the doctor because of their physical symptoms, not the psychological one's that accompany them.

So, the assessment of depression isn't necessarily clear-cut and may involve a bit of trial and error until a conclusion is reached. If however you feel your psychological symptoms are being overlooked, perhaps because you present with both physical and emotional symptoms, then speak out, or perhaps even consider changing your doctor.