The Beck Depression Inventory (BDI) is widely used to screen for depression and to measure behavioral manifestations and severity of depression. The BDI can be used for children from 13 to 80 years old. The inventory contains 21 self-report items that people complete using multiple-choice answer formats. Often, the diagnostic process begins with a visit to the primary care doctor.
Your doctor can ask you simple questions about your feelings and experiences. A physical exam, medical history, and laboratory tests will help determine if depression is related to a physiological (physical) condition. If a biological cause of depression is eliminated, your primary care doctor may prescribe an antidepressant medication or refer you for a thorough psychological evaluation by a psychiatrist, psychologist or other mental health doctor. The change to the diagnosis based on DSM IV and the inclusion of minor depression (depressive symptoms below the threshold) in the update mean that the descriptors of the previously given ranges are no longer sustainable.
The National Quality Assurance Committee recommends response and referral as indicators of successful treatment of depression for the Health Care Data and Effectiveness Information Set. Depression assessment scales and questionnaires provide ranges that are proposed to describe the different severity of depression. Depression levels in relation to HRSD and BDI in the guideline update compared to those suggested by the APA (2000b). Traditionally, the minimum duration of persistent symptoms for major depression is 2 weeks and for chronic depression (or dysthymia) 2 years.
The BDI29 is a self-report questionnaire that measures the intensity of depressive thoughts and attitudes. A combination of 2 antidepressant drugs can be considered, particularly later in the treatment algorithm, but special attention should be paid to adverse events and the burden of side effects. An inherent drawback to the use of the ICD-10 criteria for depression is that most of the treatment research on which the guidelines should be based uses the DSM—IV criteria or earlier, essentially similar versions of the DSM (DSM—III and DSM—III—R). For example, at week 4, if the patient's depression shows a partial response as determined by a QIDS-C score of 6 to 8, the recommendation is to continue with the current dose or consider increasing the dose.
The type of mental health specialist you see will partly determine how the specialist will tend to understand your depression and try to treat it. Before a doctor can successfully treat your depression, he must first accurately diagnose you. In DSM IV, major major depression can be without or with psychosis (psychotic depression) and there are specifiers that include melancholy, atypical characteristics, catatonia, seasonal pattern (seasonal affective disorder) and postpartum onset. There are many tools available to assess the symptoms of depression, but only the most commonly used ones are discussed here.
The subsequent classification of depression as mild, moderate and severe has given rise to a number of concerns in practice. In DSM IV, therefore, separate episodes are distinguished by at least 2 months from not meeting the criteria for major depression, which contrasts with the stricter requirements of the ICD-10 of 2 months without any significant symptoms. If you can manage it, it's often a good idea to meet with a mental health specialist before starting specific treatment for depression, such as antidepressant treatment.
