Tests
1st tests to order
medical evaluation
Test
Patients presenting with chronic depression should be evaluated for possible medical conditions that may cause or contribute to their psychiatric presentation. A physical examination including vital signs to determine whether there are any signs of medical illness.
Result
normal
CBC
Test
Causes of fatigue such as anemia should be excluded.
Result
normal
thyroid function tests
Test
An elevated thyroid-stimulating hormone suggests hypothyroid and an elevated T4 suggests hyperthyroid.
Result
normal
metabolic panel
Test
Metabolic panel provides a baseline and may reveal a metabolic disturbance.
Result
normal
vitamin D
Test
Low vitamin D may be associated with fatigue and mood changes.
Result
normal
Patient Health Questionnaire (PHQ-9)
Test
PHQ-9 can be used as a diagnostic and disease management tool. PHQ-9 is a 9-item depression questionnaire that reflects the DSM-5-TR criteria. It classifies current symptoms on a scale of 0 (no symptoms) to 4 (daily symptoms). It has been validated for use in primary care settings. Repeating the PHQ-9 during treatment enables the response to therapy to be monitored objectively.[34]
Result
positive result screens for depression in primary care
Beck Depression Inventory (BDI)
Test
BDI may be helpful in determining the severity of the disorder before and during treatment. It is a 21-item self-rating scale questionnaire with scoring from 0 to 4 for each item. The BDI has been validated against other rating scales that measure depression. It can be used as a screening instrument to detect depression as well as a guide to the outcome of treatment.[35]
Result
positive result screens for depression in primary care
Quick Inventory of Depressive Symptoms (QIDS)
Test
QIDS may be helpful in determining severity of the disorder before and during treatment. It is a 16-item self-rating scale questionnaire with scoring from 0 to 4 for each item. The QIDS has been validated against other depression rating scales. QIDS can be used as a screening instrument to detect depression as well as a guide to the outcome of treatment.[36]
Result
positive result screens for depression in primary care
Tests to consider
vitamin B12
Test
Vitamin B12 deficiency is associated with macrocytic anemia, paresthesia, numbness, and impaired memory.
Result
normal
urine test
Test
Urinalysis as well as possibly urine toxicology.
Result
normal
ECG
Test
ECG to determine any sign of physical illness and as baseline.
Result
normal
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