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Misdiagnosis of Depression

Misdiagnosis of Depression

A diagnosis of depression may be missed or delayed for a wide variety of reasons. For example, people with depression may fear the stigma of or be embarrassed by mental illness and not seek treatment.

A diagnosis of depression can be missed because symptoms of depression can be related to many other conditions. At the same time, depression can accompany other conditions. For example, chronic body aches and fatigue may be due to fibromyalgia, which may or may not accompany depression. Depression also often goes hand in hand with or mimics other conditions, such as anxiety disorder and post traumatic stress disorder (PTSD)....more about Depression »

Depression misdiagnosis: Depression tends to be an over-diagnosed condition and various other diagnoses are possible. Simple emotional situations such as grief may be misdiagnosed as depression (though grief can also trigger true depression), and such situations lead to over-diagnosis of depression with over-prescription of antidepressants.

There are also various medications and drug interactions that can lead to depression syndromes. Several alternative diagnoses, such as bipolar disorder (especially bipolar II disorder), delirium, dementia, thyroid disorders, fibromyalgia, CFS, PTSD, and others are also possible causes of depressive symptoms. Another common failing is that depression is often overlooked despite its general prevalence (e.g. when patients do not talk about depression but report other symptoms like tiredness, fatigue, etc.) and depression may also be under-diagnosed in certain populations such as the elderly....more about Depression »

Alternative diagnoses list for Depression:

For a diagnosis of Depression, the following list of conditions have been mentioned in sources as possible alternative diagnoses to consider during the diagnostic process for Depression:

Diseases for which Depression may be an alternative diagnosis

The other diseases for which Depression is listed as a possible alternative diagnosis in their lists include:

Depression: Hidden Causes Misdiagnosed?

Causes of Depression may include these medical conditions:

  • Depression may be directly related to a significant event in our lives such as losing a loved one, experiencing trauma, or battling a chronic illness. Other caused may involve:
  • Pre-menstrual and postnatal hormone changes
  • Hormone deficiencies
  • Alcoholism
  • Drug dependency
  • more causes...»

Rare Types of Depression:

Depression: Medical Mistakes

Related medical mistakes may include:

Depression: Undiagnosed Conditions

Commonly undiagnosed conditions in related areas may include:

Discussion of diagnosis/misdiagnosis of Depression:

Depression in Children and Adolescents A Fact Sheet for Physicians: NIMH (Excerpt)

Depressive disorders, which include major depressive disorder (unipolar depression), dysthymic disorder (chronic, mild depression), and bipolar disorder (manic-depression), can have far reaching effects on the functioning and adjustment of young people. Among both children and adolescents, depressive disorders confer an increased risk for illness and interpersonal and psychosocial difficulties that persist long after the depressive episode is resolved; in adolescents there is also an increased risk for substance abuse and suicidal behavior.1 ,2 ,3 Unfortunately, these disorders often go unrecognized by families and physicians alike. Signs of depressive disorders in young people often are viewed as normal mood swings typical of a particular developmental stage. In addition, health care professionals may be reluctant to prematurely "label" a young person with a mental illness diagnosis. Yet early diagnosis and treatment of depressive disorders are critical to healthy emotional, social, and behavioral development. (Source: excerpt from Depression in Children and Adolescents A Fact Sheet for Physicians: NIMH)

Depression in Children and Adolescents A Fact Sheet for Physicians: NIMH (Excerpt)

A child or adolescent who appears to be depressed and exhibits ADHD-like symptoms that are very severe, with excessive temper outbursts and mood changes, should be evaluated by a psychiatrist or psychologist with experience in bipolar disorder, particularly if there is a family history of the illness. This evaluation is especially important since psychostimulant medications, often prescribed for ADHD, may worsen manic symptoms. There is also limited evidence suggesting that some of the symptoms of ADHD may be a forerunner of full-blown mania.38 (Source: excerpt from Depression in Children and Adolescents A Fact Sheet for Physicians: NIMH)

Depression: NIMH (Excerpt)

Men's depression is often masked by alcohol or drugs, or by the socially acceptable habit of working excessively long hours. Depression typically shows up in men not as feeling hopeless and helpless, but as being irritable, angry, and discouraged; hence, depression may be difficult to recognize as such in men. Even if a man realizes that he is depressed, he may be less willing than a woman to seek help. Encouragement and support from concerned family members can make a difference. In the workplace, employee assistance professionals or worksite mental health programs can be of assistance in helping men understand and accept depression as a real illness that needs treatment. (Source: excerpt from Depression: NIMH)

If You're Over 65 and Feeling Depressed Treatment Brings New Hope: NIMH (Excerpt)

Some symptoms of depression also occur in other medical conditions. For example, weight loss, sleep disturbance, and low energy also occur in diabetes and heart disease; apathy, poor concentration, and memory loss are also found in Parkinson's and Alzheimer's diseases; and achiness or fatigue may be present in many other conditions. To determine the proper diagnosis, a physician must conduct a thorough evaluation, keeping in mind that depressed older people are more likely to complain of such physical problems rather than expressing sad, anxious, or hopeless feelings. (Source: excerpt from If You're Over 65 and Feeling Depressed Treatment Brings New Hope: NIMH)

Common Misdiagnoses and Depression

Rare epilepsy can cause a variety of severe emotional and depressive symptoms: The book "Preventing Misdiagnosis of Women" reports on a case of a woman with severe personality and behavioral symptoms, and a diagnosis of Borderline Personality Disorder. She had extreme symptoms such as depression, cyclic moods, relationship problems, and many other emotional and neurological symptoms. After years of unsuccessful treatment, she was finally diagnosed with the rare Temporal Lobe Epilepsy, a form of epilepsy without seizures. Treatment for that disorder was highly effective and changed her life. See Preventing Misdiagnosis of Women (by Klonoff and Landrine); see also temporal lobe epilepsy.

High rate of misdiagnosis of psychiatric disorders: The book "Preventing Misdiagnosis of Women" reports on studies that estimate that 41% to 83% of people who are treated for psychiatric disorders, actually have a misdiagnosed physical disorder. See Preventing Misdiagnosis of Women (by Klonoff and Landrine).

Physical disorders often hidden causes of depression: It is a common misdiagnosis to diagnose a psychological or psychiatric disorder, such as depression, when symptoms are actually caused by an underlying physical disorder. Some of the conditions that may cause depression-like symptoms include diabetes, thyroid disorders, chronic fagitue symptoms, endocrine disorders, and many others; see misdiagnosis of depression.

Underactive thryoid may be misdiagnosed as depression: Hypothyroidism, or underactive thyroid, is an endocrine gland disorder that is more common in women. It can mimic many diseases, including depression. The patient often has depressive type symptoms, and may also have other symptoms of hypothyroidism such as tingling fingers (peripheral neuropathy), hearing loss, headaches, cold insensitivity, and many other symptms. Common misdiagnoses of hypothyroidism include depression, dementia, schizophrenia, or bipolar disorder (esp. rapid-cycling bipolar disorder).

Adrenal gland disorder difficult to correctly diagnose: Addison's disease, a disorder of the adrenal glands, causes a variety of symptoms, and is often misdiagnosed in early stages. Common misdiagnoses include depression or schizophrenia.

Cushing's disease can be mistaken for depression: Cushing's disease (or similarly Cushing's syndrome) is a possible misdiagnosis for a person diagnosed with depression. It is an endocrine disorder with many depressive-like characteristics, but also some physical symptoms; see symptoms of Cushing's disease. Cushing's disease may also have schizophrenia-like symptoms such as paranoia and delusions, leading to a misdiagnosis of schizophrenia. Manic or euphoria type symptoms are also possible, with a misdiagnosis of bipolar disorder. See overviews of depression, bipolar disorder, schizophrenia, and Cushing's disease.

Manic-depressive (bipolar) disorder often misdiagnosed: Bipolar disorder, also called manic-depressive disorder, is often misdiagnosed before reaching a correct diagnosis. Some of the common misdiagnoses include depression and schizophrenia. See introduction to bipolar disorder.

Calcium disorder a hidden cause of depression-like symptoms: Another uncommon endocrine disorder that can be misdiagnosed as depression is hypocalcemia (low blood calcium), which is usually due to a disorder of the parathyroid gland called "hypoparathyroidism". This condition has many depressive symptoms, irritability, fatigue, and other symptoms. See overview of hypocalcemia and misdiagnosis of depression.

Various mental health symptoms caused by rare epilepsy: Temporal lobe epilepsy is a less common form of epilepsy that does not have the typical physical seizures. Patients can suffer from symptoms such as depression, moodiness, anger, irritability, and misdiagnosis of this condition as depression is common. Some patients also suffer hallucinations and other similar symptoms, or even severe psychotic symptoms, making a misdiagnosis of schizophrenia possible. Mood changes and behavioral symptoms also make a misdiagnosis of bipolar disorder possible. See the overview of temporal lobe epilespy.

Rare seizure-less epilepsy misdiagnosed as various conditions: A complex partial seizure disorder, such as temporal lobe epilepsy can be misdiagnosed as various conditions. Some of the possible misdiagnoses include depression, bipolar disorder, schizophrenia, borderline personality disorder, multiple personality disorder, somatization disorder, hypochrondria, an anxiety disorder, sexuality disorders, hysteria, and fugue.

Multiple sclerosis often misdiagnosed as mental disorder: The early stages of multiple sclerosis may cause various general feelings of wellness, happiness, euphoria, or manic-type symptoms in some patients. These symptoms may lead to a misdiagnosis of bipolar disorder (manic-depressive disorder), hypomania, cyclothymia, histrionic personality disorder, or similar disorders. Other patients may show depressive symptoms as part of Multiple sclerosis and risk a misdiagnosis of depression (i.e. non-bipolar unipolar depression). Other possible misdiagnoses of multiple sclerosis include somatization disorder, conversion disorder, neurotic disorders, or other psychological disorders. See the overview of multiple sclerosis.

Lupus is often misdiagnosed as other conditions: Systemic lupus erythematosus (SLE), often simply called "lupus", is a difficult disease to diagnose and can manifest with numerous symptoms. Some of the possible misdiagnoses include depression, bipolar disorder, anorexia nervosa, chronic fatigue syndrome, fibromyalgia, schizophrenia (a less common manifestation of lupus with hallucinations and/or delusions), conversion disorder, somatization disorder, hysteria and other diagnoses. See the overview of lupus or symptoms of lupus.

Rare copper disease insidious and misdiagnosed: Wilson's disease (a form of copper overload) is a rare disorder that has a slow and insidious onset that can often fail to be diagnosed. Copper builds up in the liver and in the brain, usually in the late childhood, teens, or 20's. Brain changes can lead to a variety of neurological and psychological type symptoms, such as speech symptoms, language difficulty, behavioral symptoms, and various others. Possible misdiagnoses include depression, behavioral disorders, schizophrenia, mental retardation, learning difficulty, anxiety disorders, hysteria, and other psychological disorders. Physical symptoms related to liver damage, such as jaundice, often appear later, leading to the delayed diagnosis. See overview of Wilson's disease.

Insidious cancer misdiagnosed as mental health condition: Pancreatic cancer is fortunately relatively rare, but this dangerous condition can be misdiagnosed as a mental condition in its early stages. Psychological symptoms similar to depression are common (including suicidal symptoms), leading to possible misdiagnoses of depression. Patients also often have difficulty sleeping leading to a misdiagnosis of insomnia (particularly with difficulty falling asleep), or some sleeping disorder, including the revere symptoms of excessive sleeping (hypersomnia). See the overview of pancreatic cancer.

Hidden diagnosis of chronic STD: The book "A Dose of Sanity" reports on a case of a many diagnosed with depression, who was correctly diagnosed with seronegative syphilis (see syphilis). The late forms of syphilis can mimic many psychological disorders.

Cluster of diseases with difficult diagnosis issues: There is a well-known list of medical conditions that are all somewhat difficult to diagnose, and all can present in a variety of different severities. Diseases in this group include multiple sclerosis, lupus, Lyme disease, fibromyalgia, thyroid disorders (hypothyroidism or hyperthyroidism), chronic fatigue syndrome, diabetes - all of these can have vague symptoms in their early presentations. Also, depression can have some symptoms similar to these conditions, and also the reverse, that many of these conditions can mimic depression and be misdiagnosed as depression.

Undiagnosed stroke leads to misdiagnosed aphasia: BBC News UK reported on a man who had been institutionalized and treated for mental illness because he suffered from sudden inability to speak. This was initially misdiagnosed as a "nervous breakdown" and other mental conditions. He was later diagnosed as having had a stroke, and suffering from aphasia (inability to speak), a well-known complication of stroke (or other brain conditions).

Alzheimer's disease over-diagnosed: The well-known disease of Alzheimer's disease is often over-diagnosed. Patients tend to assume that any memory loss or forgetulness symptom might be Alzheimer's, whereas there are many other less severe possibilities. Some level of memory decline is normal with aging, and even a slight loss of acuity may be noticed in the 30's and 40's. Other conditions can also lead a person to show greater forgetfulness. For example, depression and depressive disorders can cause a person to have reduced concentration and thereby poorer memory retention.

Dementia may be a drug interaction: A common scenario in aged care is for a patient to show mental decline to dementia. Whereas this can, of course, occur due to various medical conditions, such as a stroke or Alzheimer's disease, it can also occur from a side effect or interaction between multiple drugs that the elderly patient may be taking. There are also various other possible causes of dementia.

Tremor need not be Parkinson's disease: There is the tendency to believe that any tremor symptom, or shakiness, means Parkinson's disease. The reality is that there are various possibilities, such as benign essential tremor, which is mostly harmless. see the various causes of tremor and misdiagnosis of Parkinson's disease.

ADHD under-diagnosed in adults: Although the over-diagnoses of ADHD in children is a well-known controversy, the reverse side related to adults. Some adults can remain undiagnosed, and indeed the condition has usually been overlooked throughout childhood. There are as many as 8 million adults with ADHD in the USA (about 1 in 25 adults in the USA). See misdiagnosis of ADHD or symptoms of ADHD.

Rare diseases misdiagnosed as Parkinson's disease: A rare genetic disorder is often misdiagnosed as Parkinson's disease for men in their 50's. The disease Fragile X disorder can show only mild symptoms in the early years, and Parkinsons-like symptoms around age 50. See misdiagnosis of Parkinson's disease.

Bipolar disorder misdiagosed as various conditions by primary physicians: Bipolar disorder (manic-depressive disorder) often fails to be diagnosed correctly by primary care physicians. Many patients with bipolar seek help from their physician, rather than a psychiatrist or psychologist. See misdiagnosis of bipolar disorder.

Eating disorders under-diagnosed in men: The typical patient with an eating disorder is female. The result is that men with eating disorders often fail to be diagnosed or have a delayed diagnosis. See misdiagnosis of eating disorders or symptoms of eating disorders.

Depression undiagnosed in teenagers: Serious bouts of depression can be undiagnosed in teenagers. The "normal" moodiness of teenagers can cause severe medical depression to be overlooked. See misdiagnosis of depression or symptoms of depression.

Undiagnosed anxiety disorders related to depression: Patients with depression (see symptoms of depression) may also have undiagnosed anxiety disorders (see symptoms of anxiety disorders). Failure to diagnose these anxiety disorders may worsen the depression. See misdiagnosis of depression or misdiagnosis of anxiety disorders.

Depression: Rare Types

Rare types of medical disorders and diseases in related medical areas:

Failure To Diagnose Depression

Failure to diagnose Depression may be associated with the following:

  • Depression often remains undiagnosed because its symptoms (e.g. fatigue, feelings of hopelessness, helplessness and self-loathing, difficulty making decisions) may affect a person's motivation to seek medical advice
  • Undiagnosed depression can result in a poorer prognosis for co-existing disorders such as stroke, cancer, heart disease and diabetes mellitus
  • Women with post-partum depression are often misdiagnosed as women often feel embarrassed and don't want to appear like they can't cope with their baby
  • Undiagnosed depression can lead to suicide in serious cases and thus it is a condition that needs to be diagnosed and treated and treatment needs to be monitored over a period of time to ensure it is actually working
  • Depression is often undiagnosed as patients are hesitation about discussing their concerns because of the stigma attached to depression. People often don't like to acknowledge that they have a mental health problem
  • The symptoms of depression can vary considerably and are not always recognised by patients. A patient suffering from anger, irritability, moodiness and lack of enjoyment in activities may not realise that they actually have an illness that in most cases is treatable. The greatest hurdle is patients recognising that they have a problem and seeking help
  • Depression is believed by some people to be a normal condition in elderly people, people with chronic health problem or people facing unfortunate circumstances and thus treatment is not sought
  • Post-partum depression may occur up to a year after the birth of a baby which makes it less likely to be diagnosed accurately or diagnosed at all
  • Patients with early Parkinson's disease often have their depression symptoms overlooked as they sometimes overlap the symptoms of Parkinson's disease. Common symptoms include insomnia and fatigue. This often results in earlier treatment being recommended for the patients as their symptoms appear worse if their depression isn't treated
  • Studies indicate that women are more susceptible to depression around the time of menopause. However, often their symptoms and fatigue are dismissed as being associated with menopause. These symptoms may include anger, tiredness, easily upset, and pessimistic
  • Altered eating habits are often overlooked as a symptom of depression. The sudden loss of appetite or increased appetite may be caused by depression but may in some cases be misdiagnosed as an eating disorder
  • Symptoms of depression are often overlooked in children as many people believe that children don't get depressed
  • Depression is often overlooked when it occurs at the same time as some other major illness or event such as the death of a loved one
  • Patients with depression often present only with a sleep disturbance which is then treated as such even though it may be caused by depression. The underlying condition may be as serious as a brain tumor or relatively harmless such as a nutritional deficiency. Treatment of the underlying cause will often fix the depressive symptoms and unnecessary antidepressant treatment is not used
  • When two conditions that commonly exist together (e.g. dementia and depression) occur, the health physician often only diagnoses one of the conditions and the other remains untreated
  • Symptoms such as insomnia, loss of appetite, weakness and fatigue that occur in older people is often dismissed as normal processes of aging even though the symptoms may be caused by depression. Old people are particularly susceptible to depression, especially if they have health problems or an inadequate social support system
  • Depression in children is often overlooked as moodiness
  • Patients with depression often report only with physical symptoms such as gastrointestinal disturbances, psychomotor changes, headache and other aches and pains. These physical symptoms may be treated without considering depression as an underlying cause
  • Depression that develops slowly over a period of time is less likely to be noticed or diagnosed

Notes On Hidden Causes Of Depression

The following may be hidden causes of Depression:

  • Genetics may be involved in some cases of depression
  • Neurological conditions such as stroke, seizures, Parkinson's disease and multiple sclerosis can increase the risk of depression
  • Alcohol and the abuse of various drugs such as cocaine and narcotics may increase the risk of depression. Specific drug causes include: cyclosporine, vincristine, vinblastine, disulfiram, metoclopramide, thallium, mercury, phenothiazine, indomethacin, ranitidine, cimetidine, insecticides, reserpine, alphamethyldopa, anticholinesterases, contraceptives, corticosteroids, amphetamine withdrawal and cocaine withdrawal
  • Infections that can cause depression include: infectious mononucleosis, tuberculosis, AIDS, viral pneumonia, viral hepatitis, influenza and tertiary syphilis
  • Neurological causes of depression include: complex partial seizures, CNS tumors, stroke, early dementia, sleep apnea, Parkinson's disease, head trauma, multiple sclerosis, Parkinson's disease
  • Endocrine causes of depression include: Cushing's disease, adrenal insufficiency, late luteal phase dysphoria, diabetes, apathetic hyperthyroidism, hyperparathyroidism and hypothyroidism
  • Nutritional deficiencies that can cause depression include: B12, vitamin C, folate, niacin and thiamine deficiency
  • Psychiatric causes of depression include: generalized anxiety disorder, post-traumatic stress disorder, somatization disorder, adjustment disorder with depressed mood, bipolar disorder and bereavement
  • Organic mental causes of depression include delirium, frontal lobe dysfunction, neuroleptic-induced Parkinsonism and subcortical dementias
  • Other causes of depression include systemic lupus erythematosus, fibromyalgia, rheumatoid arthritis, pancreatic cancer and disseminated carcinomatosis
  • Chronic sleep disorders and indeed any long-term chronic illness may increase the risk of depression

Notes On Wrong Diagnosis Of Depression

Wrong diagnosis of Depression may be associated with the following:

  • Patients who present with symptoms of depression are often simply prescribed anti-depressant medications without investigation into possible underlying causes of the depression. Thus only the depression is treated and the underlying condition remains undiagnosed and untreated

Other Notes On Misdiagnosis Of Depression

  • Different people respond differently to treatments for depression. Sometimes, initial treatment may have little effect on symptoms and the health professional will need to reassess the patient and alter the treatment plan through such measures as changing the dose or changing the medication altogether

Medical news summaries about misdiagnosis of Depression:

The following medical news items are relevant to misdiagnosis of Depression:

Misdiagnosis and Depression deaths

Depression is a condition that can possibly be deadly if misdiagnosed...more »

General Misdiagnosis Articles

Read these general articles with an overview of misdiagnosis issues.

About misdiagnosis:

When checking for a misdiagnosis of Depression or confirming a diagnosis of Depression, it is useful to consider what other medical conditions might be possible misdiagnoses or other alternative conditions relevant to diagnosis. These alternate diagnoses of Depression may already have been considered by your doctor or may need to be considered as possible alternative diagnoses or candidates for misdiagnosis of Depression. For a general overview of misdiagnosis issues for all diseases, see Overview of Misdiagnosis.

 

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