Resources and Strategies

The Evidence-Informed Chiropractor


Week 8 - Depression



Following hypertension, depression is the next most common chronic condition seen in an average primary care medical office.

Depression is a significant risk-factor for a poor prognosis for many musculoskeletal conditions such as low back pain, shoulder pain, and capral tunnel syndrome to name a few.

Wells KB, Sturm R, Sherbourne CD, Meredith LS. Caring for Depression Cambridge, Mass; Harvard University Press, 1996

Two common mistakes are assuming the patient will tell you when they feel depressed and that the patient can identify the cause. For major depressive episode (MDE), neither are always true. Because MDE is due to an imbalance of neurotransmitters, there is often no initiator that the patient can identify.

Although there are a number of well-designed and valid measures for patients with major depression, the top two clues include:
  • anhedonia (i.e. loss of joy in life) and,
  • a depressed mood
These two clues if both present are 96% sensitive for major depression. They are only 57% specific though requiring mroe questioning.

Whooley MA, Avins AL, Miranda J, Browner WC. Case-finding instruments for depression: two questions are as good as many. J Gen Intern Med 1997;12(4)439-445.

These two clues when added to several other iindicators represents the best cluster for screening for depression. these are:
  • weight loss
  • sleep disturbance (e.g. early morning awakening)
  • fatigue
  • inability to concentrate or feeling overwhelmed
  • psychomotor retardation or agitation
  • feelings of guilt, worthlessness, or self-reproach
  • suicidal thought or focus on death
This totals nine potential clues which independently are not strong indicators but when 5 out of the 9 clues are present, depression is likely.

It is also important to look for a cluster of complaints which include headache, dizziness, difficulty breathing (without chest pain), and multiple joint pains. Each taken alone is not helpful but when all are present, depression is a possible cause.

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