Experiencing depressed mood, including feelings of sadness, hopelessness, or helplessness, does not always mean that you have major depressive disorder. Depressive symptoms can be related to or triggered by other medical problems, psychiatric illnesses, and substance abuse.

The overlap between depression and other medical conditions and mental disorders can make it difficult to obtain an accurate diagnosis when a patient presents with depressive symptoms.

To determine whether someone truly suffers from major depressive disorder, other potential causes of depressed mood must be ruled out. This process requires a detailed patient history, labs, a psychological evaluation, and a complete physical evaluation. This can be a lengthy process involving both your primary care physician and a mental health clinician and/or psychiatrist.

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Depression due to a general medical condition

Depression can be caused by general medical conditions that affect the body’s regulatory systems, chronic illnesses, and even surgery. Research shows that physical illnesses increase the likelihood of depressive illness, including the following:

  • Stroke
  • Heart disease
  • Chronic pain, fibromyalgia, chronic fatigue 1
  • Multiple sclerosis
  • Hypothyroidism
  • Hormone imbalance 2
  • HIV
  • Postpartum depression
  • Cancer

A diagnosis of major depressive disorder is given if the mood disturbance is not judged to be the direct pathophysiological consequence of a medical condition based on laboratory findings, physical evaluation, and patient medical history.

Substance/medication-induced depression

Substance abuse is common among people battling depressive disorders. According to the Anxiety and Depression Association of America, about 20% of Americans with an anxiety or mood disorder also have a substance abuse disorder, and 20% with a substance abuse disorder also have an anxiety or mood disorder. 3

A co-existing substance abuse disorder and depressive disorder is referred to as a dual diagnosis. The effects of medication or drug use and withdrawal from a substance can also trigger depressive symptoms. Depressed mood that only occurs within the context of withdrawal or use of a substance is considered a substance-induced depressive disorder.

Depression and other psychiatric disorders

Depressive symptoms can occur within the context of other psychiatric disorders. Appropriate diagnosis and treatment planning requires careful evaluation of the range of symptoms presented by the patient. For example, significant weight loss can be both a symptom of depression and an eating disorder and distractibility and low frustration tolerance can occur in both depression and ADHD.

Depressive symptoms can co-occur or be triggered by the following psychiatric disorders:

  • ADHD
  • Eating disorders
  • Bipolar disorder
  • Adjustment disorder
  • Anxiety disorders, including panic disorder
  • Obsessive compulsive disorder
  • Borderline personality disorder 4

Depression and grief

The bereavement process can ebb and flow and requires time. Grief can trigger symptoms of depression including sleep disturbance, sadness, changes in appetite, and fatigue. These are considered normal grief reactions. When grief reactions negatively affect a person’s daily functioning (work, school, relationships, self-care), a diagnosis of depression might be considered.

Major depressive disorder is sometimes referred to as the “common cold” of psychiatric illnesses because it can co-exist with and be triggered by a variety of other issues. Responses to significant stressors (e.g. loss, financial ruin, natural disaster) can include feelings of intense sadness, rumination about the event, insomnia, and changes in appetite. While these responses to extreme stress resemble a depressive episode, careful consideration should be paid to the environmental factors that triggered the response. To that end, a complete physical and psychological evaluation are always recommended prior to making a diagnosis.

 

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Last Updated: Jul 10, 2017