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The initial diagnosis of depression is made clinically on the basis of: • Identified pathology as a result of a psychiatric examination (based on expressed complaints or using special Research Methods or rating scales) • Anamnesis • The course, as well as etiological factors (triggers, conflicts, organic diseases) family predisposition). 

When deciding on treatment , the severity of the patient’s condition, which is recommended to be determined using the Hamilton Depression Scale (HAMD), is primarily taken into account.  

Questions for a patient with a history of depression :
• Since when has depressed mood been observed?
• Triggers and aggravating factors?
• Thoughts on fatigue from life?
• A positive family history?
• First manifestation, episode recurrence rate?
• Bipolar course (manic episodes)?
• Previous treatment?

Key diagnostic tests for depression

• Corresponding neurological status, somatic / physical examination
• Measurement of blood pressure, heart rate
• ESR, blood picture
• Electrolytes (sodium, calcium, potassium), fasting blood for sugar
• Functional kidney and liver tests
• Thyroid parameters (T3, T4, basal level of TSH)
• Vitamin B12, TRNA (test for syphilis)
• EEG
• If necessary CT / MRI
• If necessary, test for dexamethasone (monitoring the course)

Signs of a depressive episode according to ICD-10

a) Main symptoms (group 1) 1. Depressed mood 2. Loss of interest and joy 3. Decreased motivation and increased fatigue 

b) Secondary symptoms (group 2) 1. Reduced ability to concentrate and attention 2. Low self-esteem and self-doubt 3. Feeling guilty and self-worthlessness 4. Negative and pessimistic prospects for the future 5. Suicidal thoughts, plans and / or actions 6. Sleep Disorders 7. Decreased appetite 

c) Minimum duration : 2 weeks. 

d) Types of course : – recurrent (> 2 episodes) 

F32.0: mild depressive episode
2 symptoms from group 1
2 symptoms from group 2

F32.1: mild depressive episode
Minimum 2 symptoms from group 1
Minimum 3 symptoms from group 2

F32.2: severe depressive episode without psychotic symptoms
All symptoms from group 1
Minimum 4 symptoms from group 2
Lack of delirium, hallucinations, stupor

F32.3: severe depressive episode with psychotic symptoms
All symptoms from group 1
Minimum 4 symptoms from group 2
Accompanied by delirium, hallucinations and / or stupor

Diagnostic errors for involutional depression (late age) : • Depression = retirement / retirement age • Somatic depression = organic disease • Depression due to grief = ongoing reaction • Depression impairing cognitive = dementia abilities • Chronic depression = character traits  

Subtypes and specific forms of depression

• “Somatic syndrome” according to ICD-10 (“signs of melancholy”, “endogenous depression”): – “painful insensibility” – there is no emotional reaction – vital disorders (disturbances in the feeling of one’s own body) – early morning awakening, morning depression – loss of appetite / body weight  

• Involutional / Age Depression (onset after the age of 60): – hypochondriacal mood and somatic disorders are often observed – nihilistic-delusional – relatively often picture of agitation – exclude pseudo-dementia! – a tendency to chronicity – in 1/4 of the cases (approximately) it develops into an organic psychosyndrome – high comorbidity with chronic organic diseases (cardiovascular, rheumatic)  

• Somatic depressions (first of all, depression in Parkinson’s syndrome and post-stroke depression) The so-called depression on the background of exhaustion is an understandable and explainable suppressed state that occurs after, as a rule, long-term affective long-term load  

Important :
Often such “erroneous diagnoses” as “senile involution”, “beginning dementia”, “isolation” are made. High mortality / suicidal tendencies in late life.