Patient resource
How depression is diagnosed
Clinically reviewed by Josephine W. Hazeley, PMHNP-BC on · Last updated
Depression is diagnosed through a clinical evaluation — a clinician asking careful questions — not by a score on a form. The evaluation confirms the symptoms have lasted long enough and are interfering with daily life, rules out medical causes, and screens for bipolar disorder before any antidepressant is started (NIMH). A questionnaire can flag who needs that evaluation, but it does not replace it.
Knowing what a real diagnostic visit covers takes some of the mystery out of the first step. This is the deep-dive behind one section of depression treatment in North Carolina.
What counts as depression in the first place?
Symptoms that persist and interfere, not a passing low. Depression involves symptoms present most of the day, nearly every day, for at least two weeks, that interfere with how you sleep, eat, work, or connect with people (NIMH). The two-week floor and the interference are what separate a depressive episode from an ordinary rough patch.
A single sad week, however heavy, does not meet that bar. A month of not being able to enjoy anything, sleep normally, or function at work often does — and that is the point where an evaluation earns its time.
What does the evaluation actually cover?
A structured conversation about your symptoms and your life. A clinician asks when the symptoms began, how they move across the day, your sleep and appetite, your energy and concentration, your medical history and current medications, substance use, and what is happening around you. Two parts of that are easy to underestimate.
Medical causes get ruled out. Some medical conditions — thyroid problems among them — and some medications can produce the same symptoms as depression, and a provider can rule these out with an exam, interview, and lab work (NIMH). Treating a thyroid problem as depression would miss the actual issue, so this step is not a formality.
Bipolar disorder gets screened for. Depression can occur on its own or as the depressive side of bipolar disorder, which also involves episodes of unusually elevated mood or energy (NIMH). Because the two are treated differently, a careful prescriber asks about elevated-mood episodes before starting an antidepressant, not after.
Where do screening scores like the PHQ-9 fit?
They point, they don’t decide. A PHQ-9 is a validated screen that flags who should be evaluated and tracks whether treatment is working, but a score is not itself a diagnosis (Kroenke et al., 2001). It is a useful starting signal and a good progress meter — nothing more, and what your PHQ-9 score means, and what it doesn’t unpacks that. The diagnosis comes from the clinician’s evaluation, not the number.
What about anxiety and other conditions?
They get considered together, because they so often coexist. Anxiety commonly travels with depression, and sorting out which symptoms belong to which condition shapes the plan; where both are present, anxiety treatment covers that side. If your low mood is tied to pregnancy or the postpartum period, the evaluation accounts for that too — pregnancy and postpartum depression is a distinct context with its own considerations.
What’s the next step?
If the two-week, interfering pattern sounds like your recent experience, an evaluation is how you find out what it is and what to do. It can be done by telehealth anywhere in North Carolina. Request an appointment through Get Started or call (919) 739-3808. New patients are typically seen within 1–3 business days.
If you or someone you know is in crisis, call or text 988 (Suicide & Crisis Lifeline) or call 911.
Sources
- NIMH — Depression: What You Need to Know (evaluation; ruling out medical causes with exam/interview/labs; screening for bipolar disorder; symptom duration)
- Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613 (a screen flags who to evaluate; it is not the diagnosis)