Interesting. Tests and examination for depression, test Diagnostic criteria for depression

A new diagnostic test helps differentiate patients with and without depression, the results of a new study suggest.

In 2 small pilot studies, a serum test assessing 9 biomarkers demonstrated a sensitivity of approximately 91%, and a specificity of 81%, differentiating participants with major depressive disorder (MDD) from healthy subjects.

“I think these results surprised everyone,” said Dr. George Papakostas (Department of Psychiatry at Massachusetts General Hospital in Boston, Harvard Medical School).

“However, we now need to assess the reliability of the test before it is widely used as a screening tool,” he added.

Dr. Papakostas noted that the diagnosis of major depressive disorder and other psychiatric disorders has traditionally been based on patient-reported symptoms. However, accuracy may vary depending on the clinician's experience.

“The addition of an objective biological test potentially improves diagnostic accuracy and helps us track patients' individual response to treatment.”

"Despite decades of intensive study,

However, combining individual biomarkers into a single test has increased diagnostic yield.

The pilot study included 36 patients aged 18 to 65 years diagnosed with major depressive disorder (63.9% men; mean age 42.5 years) and 43 healthy participants without depression (32.6% men; mean age 30.0 years). The mean body mass index (BMI) was 27.7 kg versus 24.4 kg, respectively.

The second study included 34 adult patients with major depressive disorder (male 44.2%; mean age 43.1 years; mean BMI 30.6 kg) and compared with controls from a pilot study.

Blood samples were collected from all participants, assessing baseline levels of 9 biomarkers, including α1-antitrypsin, cortisol, apolipoprotein CIII, and epidermal growth factor. The selected biomarkers represented 4 biochemical patterns: inflammation, hypothalamic-pituitary-adrenal axis, neurotrophic factors, and metabolism.

“The individual values ​​were combined mathematically, representing the MDDScore. The test result was defined as positive with an MDDScore of 50 or higher,” the authors report.

A preliminary study found that 33 patients with major depressive disorder tested positive, compared with 8 participants without depression. The sensitivity and specificity of the test were 91.7% and 81.3%, respectively.

In the second study, 31 of 34 patients with major depressive disorder had a positive score, and the test showed a sensitivity and specificity of 91.1% and 81%.

Attempts to find an objective diagnostic tool for depressive disorder have been going on for several decades, but until recently they remained fruitless. Psychiatrists still make the diagnosis of depression based on the patient’s stories, various questionnaires, and their own experience and intuition, that is, essentially, using methods not even of the past, but of the century before last. Moreover, the main symptoms of depression, such as emotional depression, fatigue or sleep and appetite disturbances, are non-specific, that is, they can be caused by a number of different diseases, and from time to time they can also appear in healthy people. This, of course, also complicates diagnosis.

It is not surprising that as a result, patients begin treatment with a great delay, which in the USA, for example, averages from 2 to 40 months - and this does not take into account those who live like this, and often even die prematurely, not realizing that It's not like that with him.

Perhaps now the situation will change radically. Experts from the Feinberg School of Medicine at Northwestern University in Chicago published an article in the journal Translational Psychiatry about their development*, which will hopefully revolutionize the diagnosis of depression. The patient will only need to take a blood test, which will reveal the levels of 9 RNA markers associated with depressive disorder (RNA molecules play the role of “messengers” in a living organism; they “decipher” the DNA genetic code and carry out its “instructions”).

Moreover, the level of some of these RNA markers can even predict whether a patient will benefit from cognitive behavioral therapy (this approach assumes that a person’s feelings and behavior are determined not by the situation in which he finds himself, but by his perception of this situation).

According to co-leader of the work, Professor Eva Redei, who developed the test, the analysis will bring the diagnosis of mental disorders into line with 21st century standards. “Now we know that medications help, but not everyone, and psychotherapy also helps, but not everyone either. We also know that combining one with the other is more effective than using drugs or psychotherapy separately, but by combining these two methods mechanically, we are shooting short. The ability to do a blood test will allow treatment to be prescribed more accurately, taking into account the individual characteristics of patients,” says another co-leader, Professor David Mohr.

The study involved 32 people aged from 21 to 79 years who were diagnosed with the disease based on the results of a clinical conversation, and all of them had previously been involved in another study that compared the effectiveness of face-to-face and telephone sessions of cognitive behavioral therapy. In addition, some took antidepressants for a long time, but the effectiveness of such treatment was low. The control group consisted of another 32 people who did not suffer from depression.

Before the start of psychotherapeutic sessions, all participants had their levels of RNA markers measured and the measurements were repeated at the end of the 18-week course. At the start, the levels of markers in patients with depression were significantly different from those in the control group. At the finish line, the levels of 3 of 9 RNA markers changed in some of them, while in others they did not. Moreover, it was those for whom they changed who responded well to psychotherapy and showed a noticeable improvement, but for those whose analyzes remained the same as they were, psychotherapy did not help. It is these three markers, Eva Redei emphasizes, that may also indicate a physiological predisposition to depression, even if the patient is not currently experiencing a depressive episode.

Of course, this is just the first sign, and the results still need to be verified and refined with the involvement of larger groups of patients, so blood testing for depression will not become routine practice tomorrow. But if everything goes smoothly, it will certainly become: the authors intend to continue their work and, in particular, try to invent a test that would distinguish depression from the often similar bipolar affective disorder.

* E. Redei, B. Andrus, M. Kwasny, J. Seok, X. Cai, J. Ho, D. Mohr “Blood transcriptomic biomarkers in adult primary care patients with major depressive disorder undergoing cognitive behavioral therapy.” Translational Psychiatry, September 2014.

If you are seeing your doctor about depression, we will provide you with a list of tests your doctor will order. But do not forget that not all tests taken are designed to determine the presence of depression. Most are done not to detect depression, but to rule out the possibility of a more serious physical illness that may cause symptoms similar to depression.

First of all, the doctor will conduct a general examination and prescribe tests that will determine whether your condition is caused by diseases such as decreased thyroid function or cancer. If your depressive symptoms are caused by a serious physical illness, treating the illness will reduce the symptoms of depression.

What does a doctor pay attention to during a general examination when diagnosing depression?

During the general examination, the doctor will pay special attention to the nervous and hormonal systems. He will try to identify all physical ailments related to depression. For example, hypothyroidism, an underactive thyroid gland, is the most common physical ailment associated with symptoms of depression. Other types of hormonal disorders are hyperthyroidism - an overactive thyroid gland - and Cushing's syndrome - a disorder of the adrenal gland.

Many diseases or injuries of the central nervous system can also cause symptoms of depression. For example, depression is associated with any of the following conditions:

Tumor of the central nervous system

Head injury

Multiple sclerosis

• Various types of cancer (such as pancreatic, prostate, or breast)

Corticosteroid hormone medications, such as prednisone, taken for conditions such as rheumatoid arthritis or asthma, are also associated with depression. But drugs based on illegal steroid hormones or amphetamines, as well as appetite suppressants, in turn cause depression when they are stopped.

What laboratory tests will your doctor perform when diagnosing depression?

After doing a general examination of the body and analyzing the information you provide, the doctor will be able to tell whether you have depression or not. But, in order to exclude the presence of a serious physical illness, the doctor may prescribe additional tests. He or she will likely order a blood test to see if you have an illness that may be causing your symptoms of depression. Based on the results of this test, your doctor will be able to determine whether you are anemic and will check your thyroid function and calcium levels in your body.

Are there additional laboratory tests that a doctor may order before making a diagnosis?

Yes, the doctor may prescribe other standard tests in the process of examining the general condition of the body. For example, a blood test to determine electrolyte levels, liver and kidney health. Since the liver and kidneys are responsible for removing medications from the body, disruption of their function can lead to the accumulation of medications taken, and as a result, depression.

Additional laboratory tests include:

CT scan or magnetic resonance imaging of the brain to rule out the possibility of a serious condition such as a brain tumor

Electrocardiogram (ECG) to detect arrhythmia or heart block

Electroencephalogram (EEG), designed to determine the level of electrical activity in the brain

Are there special types of tests to diagnose depression?

After asking about your mood and how it affects your daily life, your doctor will ask you specific questions used when diagnosing depression. It is important to remember that all questionnaires that the doctor uses to make a diagnosis are just tools for analyzing your condition. The information obtained from these questionnaires will give your doctor a deeper understanding of your mood. He will definitely use these results when making an accurate diagnosis.

One example of such tests is a questionnaire consisting of two questions:

1. Have you been bothered by feelings of depression, depression or helplessness over the past month?

2. Over the past month, have you experienced a feeling of indifference to your once favorite activities?

The doctor’s next actions will depend on how you answer the questions. He may ask you additional questions to confirm the diagnosis. Or, if the answers indicate that you are not depressed, your doctor will do more tests to find the cause of your depressive symptoms.

In addition, the doctor may use the following types of tests:

The Beck Depression Rating Scale is a test consisting of 21 questions, the answers to which will enable the doctor to determine the degree of complexity of depressive symptoms.

The Zung Self-Rating Depression Scale is a short test that measures the severity of depression from mild to severe.

The Center for Epidemiological Studies Depression Scale is a test that allows the patient to evaluate his feelings, behavior and worldview in terms of the past week.

While taking these tests, you may be embarrassed to answer the questions honestly. In the tests you will find questions about depression and mood, depression and learning ability, physical manifestations of depression, such as decreased vitality, sleep problems or sexual dysfunction. Despite this, try to answer the questions as honestly as possible. This will help the doctor make an accurate diagnosis and prescribe the most effective treatment.

What to do if your doctor diagnoses you with depression?

Remember, depression is treatable. Therefore, getting diagnosed with depression will help you get on the road to recovery and overcome feelings of helplessness, hopelessness and worthlessness.

If you have been diagnosed with depression, follow all your doctor's advice to improve your condition. It is very important to take the prescribed medications. You should also make every effort to change your lifestyle and attend psychotherapy sessions. Millions of people from all over the world suffer needlessly from this disease simply because they do not receive adequate professional help, which begins with a diagnosis.

Scientists continue to study such a common one. This is a condition that affects a person’s behavior, worldview and sense of self. Since some representatives cross the threshold from a normal depressive state to a severe form of its development, serious treatment should be applied here.

Clinical depression is a diagnosis made by a doctor. A healthy person can also be in a depressed mood, feel a loss of strength and look at the world pessimistically. But what distinguishes him from the patient is that this condition is temporary. If a healthy person falls into a depressed state for only a few days, then the patient practically lives in a depressed mood. The longer the depressed mood lasts, the faster the clinical disorder develops.

How often is this disorder diagnosed? Readers of the online magazine site may be interested in this question, which helps to start helping loved ones in advance who, for one reason or another, have become victims of a depressive state:

1. Muscular inhibition, manifested in a passive lifestyle.
2., which affects human passivity.
3. Lack of joy in life, accompanied by constant thoughts about losses and failures in the past.
4. Negative perception of the world, often distorted due to unpleasant memories.

Scientists have conducted studies that have shown that depression has a psychosomatic effect on the body of its owner. In addition to mental illness, a person begins to develop painful symptoms that worsen his health. Thus, blood tests were carried out on some patients with depression, which showed biomarkers of an inflammatory nature. Whether they are a consequence of an emotional mood or a person has lost heart due to inflammatory processes in the body, this will still have to be investigated. But tests were carried out, during which, along with antidepressant drugs, anti-inflammatory medications were given. What results were obtained? Medicines have had a positive effect on people with severe forms of mental illness.

Just like the body has a direct impact on how a person develops and feels on a mental level. There are many mental diseases that originate in the occurrence of pathologies in the functioning of the body. If the body is sick, then human thinking changes. If the eyes and brain incorrectly perceive information coming from the outside, then the person begins to hallucinate. It also happens in the opposite direction: if an individual is mentally ill, then there is a risk of developing various psychosomatic diseases.

Depression is associated with inflammatory processes that occur in the body. What is primary remains to be seen. But the practice of psychiatrists will include a blood test, which should also take into account the physiological state of the patient, which should not be ignored. In this case, complex treatment will be prescribed, which includes not only psychological therapy to get rid of a depressed state, but also medicinal methods that eliminate the symptoms accompanying this disease. This will eliminate the possibility of depressive disorder due to body dysfunction.

Serotonin is a chemical compound that is formed in the body from the essential amino acid tryptophan. It is both a hormone and a neurotransmitter. Biologically active and performs a number of important jobs in the body.

People call it the happiness hormone because it has the ability to improve mood. Serotonin directly affects a person’s physical state, which changes with different emotions. The hormone is actively involved in emotions, determines human reactions and behavior; even determines his strength of sexual desire. Affects falling asleep and sleep duration. Its areas of influence also include: appetite; decreased sensitivity to pain; level of learning; improvement of all types of memory; control of blood clotting levels; successful functioning of the cardiovascular system, an indirect effect on blood pressure levels, the functioning of the entire endocrine system and muscles, ensuring thermoregulation.

In addition, serotonin stimulates human eating behavior, the contractility of muscle fibers in smooth muscles, causes vasospasm in the kidneys and reduces diuresis, and helps reduce allergies. It is produced in the central nervous system (brain and spinal cord - 20%), and the rest is produced in the enterochromaffin cells of the digestive tract - 80%; and this is where it is stored.

When passing into the blood, it is localized in platelets. In the central nervous system, serotonin acts as a neurotransmitter - a transmitter that carries information between neurons by transforming impulses. Serotonin from the CNS is isolated from that in the ANS.

Where does serotonin come from?

To produce serotonin, you need minerals and vitamins, not just tryptophan from food. The production of serotonin, such a necessary hormone, occurs in the brain, in the pineal gland (pineal gland).

Its mechanism of action on mood is explained not by the fact that serotonin itself gives pleasure, but by the fact that it makes it possible to feel this euphoria. In this regard, its molecule structure resembles LSD - one of the psychotropic substances, hallucinogens. It can be converted in the pineal gland into melatonin (sleep hormone). It can then influence seasonal and diurnal fluctuations in metabolism; functioning of reproduction (safety of childbirth, lactation).

Neurotransmitter function

When serotonin is normal in the blood, when it acts as a neurotransmitter, a person feels uplifted in spirit and strength; a surge of energy and good mood. Improves memory and attention. It can also reduce pain by acting as a natural opiate for pain. When its numbers are low, all these advantages disappear and the person feels pain, decreased mood, and fatigue.

How the hormone manifests itself when it enters the blood. Affects intestinal motility and synthesis of digestive enzymes; activates platelet synthesis and spasms capillaries, thereby increasing blood clotting - this is important for bleeding. This feature is used when there is a risk of bleeding.

Serotonin and depression

The influence on a person’s mood is the main feature of the work of serotonin. With depression, brain cells are destroyed and their regeneration without serotonin is impossible. With stress and depression, cell regeneration simply stops.

Taking antidepressants increases the level of the hormone, so brain cells immediately begin to renew and symptoms of depression decrease. Although measuring the hormone entering the brain is still impossible today, serotonin in depression is always reduced in the analysis. Its content in blood plasma decreases unambiguously.

For this purpose, a serotonin test is rarely prescribed. Most often, the indications are completely different areas: oncology of the abdominal organs, acute intestinal obstruction, leukemia, thyroid cancer, breast cancer. This analysis is also prescribed after surgery to remove a tumor to monitor the operation: if the indicators are high, it means either there are metastases, or the operation was not radical enough.

Symptoms that may require serotonin level testing:

• hemorrhoidal bleeding;
• signs of profuse diarrhea;
• causeless weight loss;
• intestinal obstruction;
• pathologies of the heart valves;
• frequent glossitis;
• dyspnea.

How is blood drawn?

Blood (blood test for serotonin) is taken from the cubital vein; in the morning, on an empty stomach, during the period from 8 am to 10 am (peak hormone). Very rarely, in extreme cases they can take a test 5 hours after a light snack.

Rules for preparing for analysis

The day before donating blood, the consumption of alcohol, bananas and pineapples, tea, coffee, baked goods with vanillin is completely excluded - i.e. anything that can contain serotonin. A week before the test, stop taking all medications. For 3 days, stop all physical activity and, if possible, eliminate stress. 20 minutes before donating blood, you need to sit quietly and stabilize your emotions. Serotonin testing is not considered mandatory and widespread; it is carried out only in large diagnostic centers in laboratories equipped with special reagents and appropriate equipment.

Serotonin norm

The accepted unit of measurement for hormone levels is nanogram/milliliter. But there is another decoding - micromoles/liter. To recalculate ng\ml x 0.00568. The normal amount of serotonin in the blood is 0.22–2.05 µmol/l or 50–220 ng/ml. The norm for men over 18 years old is 40.0–400.0 mg/ml, for women over 18 years old – 80.0–450.0 mg/ml.

Different laboratories perform tests using their own equipment, so results may vary. There are no international standards. You need to read the indicators that are indicated on the analysis form.

What can affect the result?

Menstruation (the first 1-2 days), migraines, obesity, and taking ranitidine and reserpine can reduce serotonin levels. The following can increase the indicators: ovulation, estrogens, MAO inhibitors, incorrect ratio of blood and anticoagulant in vitro. It can fluctuate for various reasons and then a person will definitely have problems.

Exceeding the norm

An increase in the level of serotonin occurs with: a carcinoid tumor in the abdominal cavity, with metastases; medullary thyroid cancer – then it grows 5-10 times (more than 400 ng/ml). The hormone increases slightly during myocardial infarction in the acute period; intestinal obstruction; cysts in the abdominal cavity. Of course, in oncology, this analysis will not be enough to make a diagnosis, since it is impossible to determine the size, location and shape of the tumor. Therefore, additional examinations will be required: CT, ultrasound, laparoscopy, etc.

Decrease in norm

It can occur with: chromosomal disease - Down syndrome; congenital untreated phenylketonuria, Parkinson's disease, liver pathologies and depression.

Nutrition and serotonin

Serotonin can decrease due to poor nutrition: an unbalanced diet or malnutrition. The absence of cheese, mushrooms and bananas in the menu negatively affects its production.

Proven methods to increase serotonin:

1. You need to eat foods containing tryptophan: fish and other seafood are rich in tryptophan; sour cream and kefir; red meat; nuts; cheese; pasta. Introduce bananas, millet, chocolate with high% cocoa, cabbage, and lettuce into your diet. Avoid instant coffee, alcohol and fast food. How do sweets work? They cause hyperglycemia, and insulin synthesis increases. This leads to an increase in amino acids in the blood, including tryptophan.
2. Improve your mood by gatherings, chatting with friends, visiting clubs with similar interests, and joking more. Laugh. Watching humorous programs, comedies, etc. – you don’t have to sit and wait for someone to come and increase your serotonin. Increase it yourself.
3. Sunlight accelerates the creation of serotonin, so if the weather is good, be sure to walk, participate in sports competitions, and go to parks. In cloudy weather, the sensation of serotonin action decreases.
4. Physical activity will also help increase it.

You can achieve improved performance by taking medications. These drugs include antidepressants.

There is a dangerous, life-threatening condition - serotonin syndrome. It occurs when there is a noticeable increase in serotonin levels. Its symptoms initially include signs of stomach and intestinal upset; then anxiety, body tremors, hallucinations are added, and consciousness may be impaired. Seeing a doctor is mandatory.