Depression and Anxiety: Diagnosis and Treatment

Diagnosis

A detailed history and physical examination are necessary for all patients. This should include psychiatric history, medication use, substance abuse, and social history. A physical examination should rule out disorders that are associated with depression or anxiety, especially heart and hormonal diseases. Particular attention should be paid to medications, as many can contribute to depressive and anxiety disorders.

All patients should be asked about suicidal thoughts. In patients thought to be at risk, immediate psychiatric attention is necessary.

Laboratory testing is generally not necessary, except to evaluate for medical disorders (e.g., EKG, thyroid function tests, blood counts, and blood chemistries). Urine testing may also be necessary.

The criteria for diagnosis of a major depressive disorder include at least five of the following symptoms occurring on most days within a two-week period and causing significant interference with daily life:

• Depressed mood
• Diminished interest in or pleasure from most activities
• Significant weight loss or gain, or change in appetite
• Altered sleep (too much or too little)
• Fatigue or loss of energy
• Feelings of worthlessness or excessive guilt
• Diminished ability to think or concentrate
• Recurrent thoughts of death or suicide
  

The criteria for diagnosis of an anxiety disorder include at least three of the following symptoms:

• Excessive worry
• Restlessness
• Fatigue
• Difficulty concentrating or mind going blank
• Irritability
• Muscle tension
• Sleep disturbance

Treatment

• A wide variety of antidepressant and anti-anxiety medications are available. In many cases, several weeks of therapy are necessary before the medications take effect. Successful relief of symptoms occurs in about half of patients.
• Psychotherapy may be effective used alone or in combination with medications. Treatment with a combination of medication and psychotherapy may improve the results, especially in persons with chronic depression.
• Some studies suggest that exercise may be as helpful as medications for the treatment of depression.
• Hypnosis, meditation, exercise, relaxation techniques, and avoiding caffeine are helpful in treating anxiety disorders.
• There is evidence that depression and anxiety disorders are associated with nicotine; thus, quitting smoking may be helpful.