Misdiagnosis of Depression

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.

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.

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:

Various non-disease causes of down feelings:
- Normal teenage behavior - all teenagers are somewhat moody but only about 4% are clinically depressed.
- Normal child behavior - some children are sulky, but depression is relatively rare in children.
- Grief - Down feelings from emotional loss or grief can be misdiagnosed as depression, but grief can also trigger depression.
- Burnout
- Aging - in the elderly, depression may be undiagnosed and considered normal aging symptoms.
Other types of depressive disorders:
- Seasonal Affective Disorder - a seasonal depressive disorder apparently related to sunlight.
- Bipolar disorder - Manic episodes may be overlooked and the down phase misdiagnosed as depression.
- Bipolar II disorder (type of Bipolar disorder) - Because it has milder manic episodes (hypomania), this may be misdiagnosed as depression
- Dysthymia - a depressive disorder that has milder depressive symptoms.
Physical diseases leading to depressive symptoms:
- Chronic illness - Various types of chronic illness can lead to general body slowdown, heart or lung problems, and overall down feelings.
- Post-viral syndrome
- Chronic fatigue syndrome
- Fibromyalgia - The general down feelings combined with muscle and joint aches are similar to depression in some cases.
- Diabetes
- Heart disease
- Heart failure
- Respiratory insufficiency
- Parkinson's disease - A drooping face and lack of smile from PD makes people look depressed leading to a misdiagnosis of depression.
- Brucellosis - the acute phase may be misdiagnosed as depression.
- Premenstrual dysphoric disorder (PMDD) (type of Premenstrual syndrome) - PMDD was misdiagnosed as depression in the past but is better known now.
- Thyroid disorders
- Hashimoto's thyroiditis - a form of hypothyroidism.
- Post-polio syndrome
- Hypersensitivity pneumonitis (type of Interstitial lung disease) - Also called "farmer's lung"; a chronic lung condition that is sometimes similar to depression.
- Hyperparathyroidism
- Adrenal disorders
- Adrenal Insufficiency
- Hypoadrenocorticism
- Addison's disease
- Celiac disease
- Pancreatic cancer
- Early Menopause (see Menopause) - misdiagnosed as depression in younger women when menopause is not expected.
- Alcoholism - For example, late-onset alcoholism is a cause of depressive symptoms that is often overlooked in seniors and the elderly.
Other types of mental illness:
- Dementia
- Post-traumatic Stress Disorder - may be misdiagnosed as depression
- Body dysmorphic disorder (BDD) - The preoccupation and emotional problems of BDD can sometimes be misdiagnosed as depression.
- Schizoaffective disorder - usually has delusions and hallucinations preceding depression.
- Schizophrenia - early symptoms of schizophrenia may be like depression.
- Delusional disorder
- ADHD - Probably not a common misdiagnosis, but ADHD has been mentioned as misdiagnosed as depression.
- Delusional disorder
- Psychotic disorder
- Adjustment disorder
Other brain diseases that affect mental functioning:
- Stroke - A stroke episode can lead to dementia or depressive symptoms
- Alzheimer's disease - The early stages of AD can be misdiagnosed as depression.
- Parkinson's disease
- Huntington's disease - This brain disease can lead to depressive symptoms
- Cerebrovascular conditions
- Mild traumatic brain injury (MTBI) - Any minor brain damage such as a car accident, assault, injury, or fall can lead to delayed depressive symptoms.
Delirium
- Hypoactive delirium
- Postoperative Delirium
Sleep disorders - Any loss of sleep can sometimes lead to depressive symptoms.
Drug interaction (type of Adverse reaction)
Other causes of depressive symptoms

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

Discussion of diagnosis/misdiagnosis of Depression: 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. ¹

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. ¹

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. ²

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. ³

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

Misdiagnosis cases for Depression: No cases available yet.

Footnotes:
1. excerpt from Depression in Children and Adolescents A Fact Sheet for Physicians: NIMH
2. excerpt from Depression: NIMH
3. excerpt from If You're Over 65 and Feeling Depressed Treatment Brings New Hope: NIMH

Last revision: July 1, 2003

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