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What Depression Screening Tests May Miss

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I’ve been diagnosed with depression and panic disorder for years. Throughout my journey, I’ve cycled through multiple doctors and walked through countless waiting rooms. I’ve seen psychiatrists and gone to primary care doctors for mental health concerns. 

When I go to my primary care doctor, describing my mental illness comes down to filling out a short survey on depression and anxiety. You might know the exact survey I’m talking about. You may even have the questions memorized. 

In the past two weeks, have I felt on edge? 

Do I have difficulty falling asleep or staying awake? 

Have I felt down? 

Did I feel bad about myself? 

To each, I answer some form of “yes.” “Several days.” 

I want to say more, but there’s no option for description. There’s no place to detail how one day I felt completely overwhelmed by life and the next, OK. There’s no way to convince my doctor through this piece of paper on a clipboard that I’m living instead of hiding in my bed all day. 

My answers are added up and given a score. It’s like a grade on an elementary school multiplication exercise, except this score has the potential to stick with me for a while, moving from medical chart to medical chart and huddling next to all the other scores to create a picture of my mental state. 

Or does it? Does this score mean anything in terms of how I’m coping with my mental illnesses? 

Diagnosis is incredibly important. These simple tests help determine whether someone is depressed or not. It’s supposed to work like a snapshot of a person’s mood, a Polaroid photo that develops instantly to give a general image the doctor uses to suggest treatment. The picture can show whether a person needs medication or therapy.

The picture is sometimes blurry, though. Maybe it’s not fully developed, or maybe there’s one detail out of focus. It’s not the whole story. Although diagnosis is important, diagnostic questionnaires can’t encapsulate the entire experience of mental illness. 

If the test score is high enough, my doctor’s face changes slightly. She looks at the results and says, “I think we should consider upping your dosage.” 

First, an important disclaimer: I’m fine with taking medication. I wasn’t always in the past, but I am now. Medication keeps me functioning. I might need it the rest of my life to function. I’ve accepted this. So when my doctor says I need a higher dosage, it’s not the idea of taking more medication that irks me; it’s that I don’t always think I need it. It’s sometimes like someone telling me I’m experiencing symptoms when I know I’m not. 

When my score is just over the line, I don’t feel like I’m on the edge of a downward spiral. I just feel like a person who worries at times and is sometimes sad. The screening test doesn’t always distinguish regular ole feelings from a depressive episode. Generally, when I go into the doctor’s office, I feel like a “normal” person managing an illness and for the most part, succeeding. I’ve been at this long enough that I’m generally aware of my symptoms and when I need to ask for help. 

Not every person with a mental illness has the ability to do this. There are those of us who do, though. It’s perfectly fine to play an active role in treatment, to tell your doctor what treatment means to you. Maybe you don’t want to feel anxiety or depression even the least bit. That’s fine. Treatment should be designed to fit the needs and, within reason, desires of the patient. When my doctor suggests a higher dosage, I’m not afraid to have a conversation about what I want out of treatment. I’m not afraid to say I don’t want to be overmedicated, I just want to be medicated enough. 

I’ve always thought of medication as the thing that helps move me from below the surface to close enough to the surface that I can reach the air above. Medication gives me the ability to help myself, to use my breathing techniques when I feel panicky, instead of letting the panic take over. Practicing these techniques and working through my symptoms strengthens my ability to cope with my illness. 

Luckily, my doctor understands this. Even though the suggestion is on the table, I’m not pressured into taking it. Although the screening tests irk me sometimes, I understand their use. I know a piece of paper on a clipboard can start an important conversation about a person’s mental health. I also know I’m allowed to make important decisions about my mental health care.

Originally published: March 5, 2016
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