How Primary Care Doctors Try to Spot Depression

12/7/10.  Four core components of depression:

• Impairment of mood.
• Often sad, irritability often missed as symptom of depression.
• Loss of previously enjoyed activities and pleasures.
• Amotivation and withdrawal from activities.
• Stress intolerance --- no bounce to the tires.

Ask two questions:

• How's your mood?
• Still doing the things you like to do, and enjoying life?

Must rule out four things:

• Suicidal Ideation.
• come right out and ask the question about ideas about self-harm - the question won't make things worse, Do you plan to kill yourself? What are you planning to do?
• Psychosis.
• ask about hearing voices or seeing things.
• Substance Abuse.
• Bipolar Disorder.
• Have you ever had time in the past when you've gone a few days or more the opposite of depressed, not just normal, but so full of energy that other people couldn't keep up with you, your thoughts were racing, you couldn't sleep, you did impulsive things like buy a car on the spur of the moment, or start a love affair with a stranger, or have grand schemes to start a new business?

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