Doctor Reflects On Missing Depression Symptoms

Doctor Reflects On Missing Depression Symptoms

By Kelly Burch 02/05/19

“Psychiatrists are the experts in making the diagnosis, but primary care doctors like me are the ones who most frequently do make the diagnosis—although they may not catch it every time.”

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Doctor discussing depression with patient

Long before Dr. Keith Roach was helping others get better, he himself was depressed. Only, he didn’t know it at the time. 

Despite being overwhelmed by feelings of despair, Roach, an associate professor in Clinical Medicine at New York Presbyterian Hospital and Weill-Cornell Medical College, never thought to ask for help, he wrote in a recent piece for Men’s Health

“It certainly didn’t cross my mind to see a doctor: I was 17 years old and in perfect health. The idea I might not be in perfect mental health didn’t even cross my mind,” he said. 

It was only in medical school that he realized that what he experienced was more than teenage angst—it was clinical depression. 

“I finally realized that I had been through a pretty textbook case of major depressive disorder. It was a bit of a shock reading about it,” he wrote. 

Doctors use diagnostic criteria in the DSM-V to determine whether a patient has depression. Although the criteria—which include “depressed mood most of the day” and “moving or speaking more slowly (or much more faster) than normal”—seem straightforward, they contain a lot of nuance, which can cause doctors to miss depression diagnoses, Roach said. 

“Experience is essential because interpreting the answers to the questions requires judgment: it isn’t always a simple yes or no answer,” he wrote. 

Oftentimes, primary care doctors, who don’t specialize in mental health, are the ones screening patients. 

Roach wrote, “Psychiatrists are the experts in making the diagnosis, but primary care doctors like me are the ones who most frequently do make the diagnosis—although they may not catch it every time.”

In addition to helping educate doctors on the nuances of diagnosing depression, Roach reminds patients that it’s important to advocate for themselves and bring their symptoms to the attention of their medical provider. 

“Even in 2019, there remains a stigma to mental illness, and many people (especially men) feel that depression is a sign of weakness, and they are loath to admit it, to themselves or to people who might help them. This is a barrier I have had to fight many times,” Roach wrote. 

Sometimes, people with depression need to ask friends or family to help them seek medical care. 

“One barrier to treatment of depression is the depression itself,” Roach wrote. “Some people have an overwhelming fatigue that prevents them from going to see someone about it.”

Although it has been more than 30 years since Roach experienced feelings of depression, he still monitors himself for signs and asks his loved ones to do the same.

He said, “If they recognize that I am not myself they can feel safe in letting me know so that I could get treatment sooner. I don’t want to feel that way, and my family, coworkers, and friends don’t want that for me either.”

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.

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