How long does a psychiatrist need to diagnose a disorder?

May 31, 2007 4:43 PM

Can a psychiatrist diagnose a disorder in five minutes?

I've been depressed and anxious all my life, or so I thought. I'm in my twenties, and I finally went to a doctor about it. He spent about five minutes with me, then diagnosed me with Generalized Anxiety Disorder. He told me I'm not depressed because I don't have a low appetite and because I sleep too much instead of too little. I certainly feel depressed, but he said that without those physical symptoms, I'm not.

Is it normal to get a diagnosis this quickly or is something off? A second opinion can get expensive, so I'm trying to work out if it's necessary.

posted by giggleknickers to health & fitness (34 comments total)

He told me I'm not depressed because I don't have a low appetite and because I sleep too much instead of too little.

Idiot.

(Not you -- the shrink!)

No, that's not normal. Googling around for self-tests and the like would probably help you work out how off he was. (Not knowing what else you discussed...)
posted by kmennie at 4:54 PM on May 31, 2007

Feeling depressed is a consequence of the anxiety disorder. If he treats well for GAD, the feeling of being depressed will disappear. It happened to me in the past, and the doctor diagnosed me in less than 20 minutes.
posted by dcrocha at 4:55 PM on May 31, 2007

It's perfectly normal. Clinical Depression (CD) isn't just "I feel sad", it's a biochemical condition that expresses itself in specific behavior patterns. If you don't have those patterns, you don't have that disorder. You notice the doc didn't say you didn't have any disorder, just not CD.

GAD has lots of similar symptoms to CD, but treatment can be radically different...sometimes it the exact same medicine. Is there some reason you're unwilling to try the treatment recommendations for GAD? Is the name of your condition really more important that getting it treated?
posted by nomisxid at 4:56 PM on May 31, 2007

Seconding the "idiot!" Here's my 3 second diagnosis. IANAGYAD (I am not actually giving you a diagnosis) Atypical Depression.
posted by thebrokedown at 4:59 PM on May 31, 2007

Sleeping too much is one of the telltale symptoms of clinical depression.
posted by Roach at 4:59 PM on May 31, 2007

It depends on the disorder. It's not by any means impossible, and it doesn't necessarily mean the therapist is a bad one.

Over the last twenty years or so the psychiatric profession has been trying to systematize diagnosis and trying to make diagnosis consistent between practitioners. To that end, an industry body (or whatever the medical equivalent is) has produced a series of books known as the "Diagnostic and Statistical Manual of Mental Disorders". I think the current version is DSM-IV.

Here's the current diagnostic description of Generalized Anxiety Disorder:

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The person finds it difficult to control the worry

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.

 restlessness or feeling keyed up or on edge
 being easily fatigued
 difficulty concentrating or mind going blank
 irritability
 muscle tension
 sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in a Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder.

E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

F. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

Now you may not have noticed it, but I would guess that during that five minutes the doctor asked you some specific questions, which were relating to the list above of diagnostic signals.

If a case is clear cut, it doesn't really take all that much to figure it out.
posted by Steven C. Den Beste at 5:00 PM on May 31, 2007

By virtue of the fact that unipolar depression/bipolar disorder/GAD/etc.etc.etc are regarded as existing on a continuum, and there are combinations of symptomatic elements present in any given patient that DON'T fit the DSM-IV's diagnostic structure, 5 minutes is much to short a time to make a proper diagnosis.

IANAD, but I am the son of a doctor and a student of biology, and 5 minutes is not enough!

In fact, "5 minutes" is what frustrates me so much about mental health care in this (and most) countries!

I don't have the time right this second to expound, so I will just say that your instincts are correct and if there is any viable route to obtain a second opinion you should do so.

I take p-meds (psych-meds) every day and I have since 1999, but it took proper consultation and care to figure out what those meds were going to be, and at what levels.

5 minutes does NOT cut it.
posted by Roach at 5:17 PM on May 31, 2007

I'm not resisting treatment. I just want to know if he can give me a diagnosis this fast. I don't see why that would be an unreasonable thing to ask about.

I prefer it not to be dismissed as just feeling sad. It takes every bit of strength I can conjure to keep from killing myself to make the pain stop. Just getting out of bed is a battle.

Steven, in C) I only have the difficulty concentrating and easily fatigued. Even the difficulty concentrating part is quite recent and I've been feeling depressed since forever. I am embarassed in public, but that's because I'm very ugly and overweight, so I think it's pretty natural.n My doctor didn't ask about any of the things from C or D except if I have a low appetite and if I have insomnia. Is that a red flag, do you think?
posted by giggleknickers at 5:18 PM on May 31, 2007

Now I'm sorry for my flippancy. (Though given the very limited information that was presented in the question and only 5 minutes in which to form an opinion, I still stand behind atypical depression.)

Here are a few follow-up questions that the doctor (? Was he a GP? A psychiatrist? Other?) should have asked given the 5 minute visit. If these weren't at least cursorily covered, please get a second opinion:

-fam history of anxiety and depression? Family health issues?
-when was last physical? Any heart issues, thyroid issues, any cocommitant physical complaints such as headaches, muscle pain, strep, mono?
-what are environmental stressors?
-what are the specific behaviors or feelings that cause you to feel that you are depressed?

Diagnosis, IMO, is all about asking the right questions. Did he/she ask them?
posted by thebrokedown at 5:22 PM on May 31, 2007

giggleknickers,

Feel free to contact me.

I have to leave shortly but I just want to reiterate that I know that YOU know that you deserve more than that 5 minutes for your money, especially when your life is on the line, and that doc's job is ultimately to be a life-SAVER, and not just to kick you down an Effexor prescription.
posted by Roach at 5:25 PM on May 31, 2007

As others have stated before, it's totally possible to be depressed and have your symptoms include sleeping too much and eating too much. I don't know, in general, about diagnosing you within 5 minutes -- or if, in fact, he is correct and your problem is GAD -- but it's BS to say that without insomnia/lack of appetite you're not depressed.
posted by katemonster at 5:25 PM on May 31, 2007

The answers are pretty mixed, all from people who sound like they know what they're talking about. I'm still confused!

thebrokedown, so five minutes is enough as long as it's the right questions? He didn't ask the first three. He didn't ask the fourth as an open question, but a laundry list of symptoms such as if I feel like someone is following me. I didn't fit most of the symptoms he listed, except feeling like everything is hopeless and wanting to die.

The Atypical website says that people get better when something good happens. I've spent my life trying to find things that make me happy and working towards finding that something that makes me happy is the only thing that has kept me going. I've pretty much come to the conclusion that nothing in life will pull me out out of depression, which is why I figured it's time for the doctor.
posted by giggleknickers at 5:31 PM on May 31, 2007

giggleknickers - you're obviously unhappy with the time the doctor spent on your case before diagnosing you. Either express that fact to him/her, or seek out a second opinion.
posted by muddgirl at 5:35 PM on May 31, 2007

By the way, how would a person know if there was a history of depression in the family? I can't diagnose myself, so how could I diagnose my relatives?
posted by giggleknickers at 5:36 PM on May 31, 2007

giggleknicker, I didn't mean to come across as saying you "just feel sad", I simply meant that, as others have put more eloquently, disease names mean something more to the medical professional than to the layman. There is a decision tree that a doctor follows when attempting a diagnosis, and it is very easy for an early question to rule out a specific disorder.
posted by nomisxid at 5:47 PM on May 31, 2007

I'd be more concerned that what he told you isnt true, rather than the time he spent diagnosing you.
Sleeping too much can be a sign of depression as can eating too much. These are standard questions on any 'depression inventory' I've ever been given - its a standard questionairre for assessing depression symptoms - usually given to you by a regular GP before sending you to a psychiatrist (speaking from UK experience here) or to assess any change in symptoms during on-going care where you might not see a psychiatrist every week.

But dont dismiss him too quickly, what treatment did he prescribe for you? At the very least give it a try, perhaps you misunderstood him or he wasnt being very clear about his reasonings.... or maybe he's just an arrogant sod that doesnt like patients self-diagnosing ;)
posted by missmagenta at 5:49 PM on May 31, 2007

missmagenta, thank you for asking. He prescribed me Zoloft. I don't like it, because it makes me feel really indifferent. I've kind of lost the sense that anything I do or that happens in my life will affect me. It's better than feeling miserable, though. It's done nothing for the anxiety, though. In fact, I think it's made my anxiety worse because I'm terrified I could gain weight.

Anyway, I'm not dismissing him. I just want to understand what's going on with me and my treatment. I wish the process had been more transparent. The question wasn't meant to be a leading one. It's a genuine, open question about something I don't understand and would like to know more about.
posted by giggleknickers at 5:57 PM on May 31, 2007

No, 5 minutes is an absolutely ridiculous amount of time on which to predicate a diagnosis of a seemingly life-long problem.

As for family history--any suicides? (I know that this is a cause of death frequently hidden.) Folks that have been in long-term care? Family history of prison? That sort of thing.

Look, people are complicated. Depression and other mood disorders are complicated. You feel cheated by your visit to the doc, and that is enough to warrent another opinion.

You didn't disclose the doc's resolution to the presenting problem--meds, I'm guessing. That info might be somewhat helpful in determining what the thinking was. My email is deadmandancing at gmail.com, if you want to discuss further.
posted by thebrokedown at 5:58 PM on May 31, 2007

How is he treating you? Is it ongoing treatment or did he brush you off? When I had clinical depression the diagnosis was pretty quick and clear cut, but the treatment plan laid out wasn't. That part took more than five minutes to determine, particularly as it was aimed at keeping me safe as well as making me better. This is what you need, particularly the keeping safe part by the sounds of your comments. If you're not getting decent treatment and you're unhappy with the diagnosis then definitely go for a second opinion. If you feel the treatment he outlined is worth a shot and will keep you safe then decide if you want to give it a try.

FWIW I slept 18 hours a day and gained 20 kg from eating chocolate when I was clinically depressed. I was not misdiagnosed, had no other mental illness issues, mood disorders or complicating factors (e.g. anxiety), and responded well to Prozac. It was very clear cut clinical depression. My symptoms weren't unusual within my support group, although insomnia was also common. It's been a while since I read the DSM-IV for depression but my experience indicates that insomnia and appetite suppression don't immediately preclude classic clinical depression. However your anxiety symptoms may mean your doctor was looking for a different type of depression where these things are relevant. At the least he should be able to explain this to you.
posted by shelleycat at 5:58 PM on May 31, 2007

Re: family history. Some people know that there's a history of depression in their families because their family members have been open with them about being diagnosed and treated for depression or other mental illness. Some people may have seen Prozac in mom's medicine cabinet or know that Uncle Joe committed suicide. Other times, you may suspect because you see symptoms of mental illness in family members (perhaps the same sorts of symptoms that led you to seek treatment yourself) that you can describe to a doctor and ask whether those symptoms may be indicative of depression or some other mental illness. If you don't know, tell the doctor that you don't know.
posted by decathecting at 5:59 PM on May 31, 2007

Who knows whether 5 minutes is enough or to little--I tend to go with Steven C Den Beste response--While cognitive-behavioral interventions might be different (very little though) there are virtually no differences in initial medications--SSRIs. This is particularly true since yours is a long standing recurrent condition condition. While an anxiolytic might be prescribed for the anxiety this is not considered first line. If you do not respond in 4-8 weeks to the SSRI the dosage maybe increased, another SSRI may be prescribed or they might augment the initial drug. Axxiolytics are primarily used for acute anxiety, anxiety that is clearly disabling, or to minimize possible initial side effects of an SSRI This is when the fun starts and you need to be very comfortable with your physician. BTW, The very nature of your question and concerns does suggest anxiety and not uncomplicated depression. Best Wishes
posted by rmhsinc at 6:13 PM on May 31, 2007

Please hang in there! These meds are lifesaving for a lot of people. Zoloft is probably what you'd get prescribed if you were diagnosed with depression too, so keep taking it. Remember that you need to take it for at least 2 weeks, maybe 4 weeks, until you get the effect. Also, you sound like you are suicidal. My email's in profile - I would love to talk to you more. I lost my mother to suicide so I am on a one-woman campaign to talk to people about it.

Remember, the risk of suicide actually goes up right after you start taking antidepressant meds. The symptoms of depression don't all lift at the same time - you get your energy back before your depression lifts, which means you suddenly have the energy to make a plan to commit suicide and carry it out. So if you recently started taking it, you are at the most vulnerable point. You may not believe it, but hanging in there for a few weeks will make a tremendous difference in your mood.

In the US at least, a free resource is the pharmacist. In the US, pharmacists go to school for nearly as long as doctors and should be able to tell you a lot about the various antidepressant and antianxiety meds out there. There are a ton. Recent research shows most people need to try out 3 meds before finding one that works for them.

As a perenially depressed person myself, I've got to say that we are very very lucky to be living in a time when so many medications are available. I really do think you can find one that will make you feel a whole lot better. I will be thinking about you.
posted by selfmedicating at 6:44 PM on May 31, 2007

Oh, and it's pretty unlikely you'll gain weight on Zoloft. Most people actually lose weight. That's true for many of the newer antidepressants, so whether you stick with Zoloft or find something you like better, you may get weight loss as an added bonus.
posted by selfmedicating at 6:46 PM on May 31, 2007

Was the doctor a regular MD or a psychiatrist? I was perfectly comfortable getting medication from my GP for anxiety when I knew that the anxiety had a clear cause (serious illness of a family member) and it would be relatively short term. However, when a loved one was dealing serious depression, it was totally worth the money to get an psychiatrist involved - they really know the options and the trade-offs as well as the risks and off-label uses of the medicines.

Also, I strongly recommend that you find a therapist that you like and trust. Medication and therapy do about equally well in treating depression (although medication works faster). However, therapy is much better at preventing a relapse. Overall, if you are willing to take meds, the combination of medication and therapy usually gets the best results.
posted by metahawk at 6:58 PM on May 31, 2007

Get a second opinion and get screened for bipolar type 2. Atypical depression (which is sleeping and eating too much) is common with it, not to mention anxiety and jumpiness can be hypermania.

I know this is costly (the second opinion) but this stuff is hard to diagnose and if your doc prescribed medicine it is vitally important for you to be treated for the correct thing.
posted by konolia at 7:40 PM on May 31, 2007

I just saw you were prescribed Zoloft.

IF you start feeling really really jumpy and manic call your doc stat. If you are an undiagnosed bipolar you will very quickly become a diagnosed one!
posted by konolia at 7:42 PM on May 31, 2007

You said yourself you've been depressed and anxious most of your life. Major Depression and Anxiety Disorders are often co-ocurring, so having one doesn't necessary exclude the other. You may have two or three valid diagnoses by the time you find the right treatment for you.

The difference between depression and anxiety is that depression is excessive, prolonged sadness plus lack of motivation, while anxiety indicates being hyper-alert and having a vague sense of impending doom at any time. People who are depressed tend to be lethargic. People who are anxious tend to have "an excessive startle reaction" to even quiet interruptions.

Both are disorders of desperation, and often, intense pain. Both can affect your sleep patterns, but people with anxiety alone don't experience as much weight fluctuation because anxiety doesn't have as much affect on eating habits as does depression.
posted by mynameismandab at 8:36 PM on May 31, 2007

And to answer your question, psychiatrists are not therapists.
They are trained to jot down your symptoms, applicable family medical and psychiatric history, quickly compare them to what they know about common disorders, and make efficient diagnostic and treatment decisions. Most psychiatric appointments last fifteen minutes or less.

So, yes, a well-trained and experienced psychiatrist Could make an educated guess (which is all a diagnosis is, anyway) and go from there.
posted by mynameismandab at 8:45 PM on May 31, 2007

You can learn more about any meds you might be prescribed at Crazy Meds (warning: some strong language, circa-1997 web design, and a big banner on the front page that reads 'Crazy Meds Suck Donkey Dong').

And for the record, a lot of the DSM (Diagnostic and Statistical Manual) is exactly what you got: Lists of symptoms, plus a key that says the doc can diagnose X disorder if you scored N symptoms from column A and M from column B.
posted by eritain at 9:59 PM on May 31, 2007

I've been diagnosed with panic disorder and depression. Whichever is the more pressing concern changes from time to time (over years) - right now, the depression is overwhelming, so that's the biggest concern, though earlier this year I was going through more panic attacks than anything else. Anxiety and depression do often hang out together, and sometimes treating one helps treat the other.

I'm on Efexor right now and it does make you indifferent at first. The idea is to get you stable first before getting your mood up. (I've been on other antidepressants previously and the effect was similar.) It SUCKS, yes. I feel for you. And I can attest to the "risk of suicide is higher" part - I've actually felt more suicidal lately, though I haven't actually acted on it. I whine for a while and then feel better.

5 minutes is far too short, you do deserve a second opinion. Though it may end up being the same diagnosis. My first diagnosis was rather quick, then after a while I got diagnosed and medicated for schizophrenia and Tourette's (!! didn't take those meds!), and then a year after the initial diagnosis I got an indepth interview at John Hopkins. Verdict? Panic disorder and depression. ha.

But get a second opinion anyway if that helps. Good luck. Hang in there.
posted by divabat at 12:46 AM on June 1, 2007

(oh, I should clarify that the schizophrenia and Tourette's diagnosis were made by other doctors and psychologists, not my primary [at the time] psychiatrist. I was moving around at the time. Turns out that the tics and "voices in the head" were just part of the overall anxiety.)
posted by divabat at 12:47 AM on June 1, 2007

And on third post (I swear I'll stop!!): ever since I went on the Efexor I've been sleeping like crazy. I'd be out by 9 or 10pm almost like clockwork. So oversleeping can be part of depression.
posted by divabat at 12:49 AM on June 1, 2007

psychiatrists are not therapists

Therapy is the attempted remediation of a health problem, usually following a diagnosis. To say that psych's are not therapists is simply not true and framing it as such very much depends on whether the psych has trained in one or more counselling and talk therapy approaches during residency and afterwards. If in doubt, ask them! Your psych could even be a registered massage therapist and you might never know.
posted by meehawl at 8:16 AM on June 1, 2007

Five minutes is not enough. With the wrong doc, five years might not be enough. It took over two years of working with a wonderful psychiatric nurse practitioner and over 20 medications to figure out a diagnosis that adequately describes my mental issues. From Panic to Depression to Bipolar to GAD to ADHD. It is an ongoing process.

What I have learned is that they know far less about brain chemicals than they let on. And your first diagnosis is conditional, at best, because they figure out just as much about your condidtion by how you respond to various meds as they do from what you tell them. What your condition is called is far less important than finding a treatment that works for you. More important still is that you don't continue when something isn't working, as long as you've given it a fair trial. (IANAD, YMMV, etc.)

The previously mentioned CrazyMeds site is an excellent resource for real life medication info, although it is more tilted towards bipolar than other specific conditions. For extensive info on medications check out the Merck manual, the Physician's Desk Reference (PDR), and other guides in the same section of your local library.

Also, now that you have a diagnosis (even if you don't think it works), you could do what I did, which was to forgo more sessions with a psychiatrist (super expensive), and instead I asked to see someone for "medication management." In my experience, nurse practitioners are far better listeners than doctors, can prescribe medication just as well, and are way cheaper!

Take good care of yourself, and listen to your instincts.
posted by monopas at 9:30 AM on June 1, 2007