Merriam-Webster defines “depression” as “a state or spell of low spirits.” It lists dozens of synonyms for it such as:
blues, dejection, desolation, despond, despondence, dispiritedness, doldrums, downheartedness, dreariness, dumps, forlornness, gloominess, glumness, heartsickness, joylessness and melancholy
But clinical depression is much more than having the “blues” or being temporarily overcome with sadness after the death of a loved one, for example. The National Institutes of Health says Major Depressive Disorder “causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working.” These symptoms must be present for at least two weeks.
If you have been diagnosed with Major Depressive Disorder (MDD), your doctor may have used terms that may not be familiar. Understanding the language used by healthcare providers and learning how the severity of depression is determined can help you better communicate with your doctors.
How Depression is Diagnosed
One of the first steps in diagnosing MDD is to determine the severity of your depression. One of the most commonly used diagnostic tools is the Hamilton Rating Scale for Depression-17 (HAMD-17).
Your healthcare provider may ask you to take this 17-question test, which generally takes 20 minutes. Some of the questions the test asks include:
- Do you have a depressed mood (e.g., sadness, hopeless, helpless, etc.)?
- Do you experience feelings of guilt?
- Do you have thoughts of suicide?
- Do you have insomnia early in the night? In the middle of the night? Early hours of the morning?
- Do you have trouble working?
Each of the questions comes with a severity rating from zero to four; for example, if you aren’t having any trouble working, that item would receive a “0” as a score. However, if you have stopped working because of your depression, that would be rated as a “4.”
Before treatment is given, the healthcare provider tallies the score to determine your depression severity and compares it to a HAMD-17 depression severity rating scale:
- 0-7: No Depression
- 8-13: Mild Depression
- 14-23: Moderate Depression
- 24+: Severe Depression
After the depression severity is determined, your doctor will often discuss how to improve your score and lessen your depression. He or she will work with you to identify an appropriate course of treatment. There are many ways to treat MDD, including medication (most commonly prescribed are antidepressants), psychotherapy, diet and exercise changes, and a host of other treatments.
Regardless of the treatment regimen, the doctor’s goal is to see a reduction in the type and severity of your depression symptoms. Specifically, your healthcare provider may use the following terms to discuss depression treatment goals:
- Symptom Improvement: Any reduction in your HAMD-17 score (i.e., 22 to 18)
- Response: A greater than or equal to 50% decrease in HAMD-17 score (i.e., 22 to 11).
- Remission: A HAMD-17 score has decreased to 7 or below (i.e., 22 to 6). This is the ultimate goal for your healthcare provider and you.
Depression Remission is the Goal
Achieving remission can be a long and hard road for people who suffer from clinical depression. If you’ve suffered through a “trial-and-error” process of finding the right antidepressant medication, you know how frustrating this journey can be.
You aren’t alone. One in six Americans develop MDD in their lifetime. Yet, fewer than half of all depressed patients respond well to their first prescription and overall treatment failure rates exceed 50 percent.
One of the reasons could be that the medication(s) you are taking may not be compatible with your genes. Genetics vary patient to patient – and a medication that worked for one person may not work with your DNA. Accordingly, medications can be more effective when a doctor understands your unique needs, based on how genetic variation might affect your medication response.
GeneSight® provides that insight. The GeneSight Psychotropic Test analyzes how your genes affect your response to depression medications and can guide you on the path to wellness.
For more information on how depression is rated, please visit our infographic here.