Learning the Tricks of the Trade- how doctor's think about depression

As a newly minted (and terrified) physician, I can't help but look back at my life 4+ years ago and think about how what I know NOW would have been incredibly helpful THEN. Mental illness and suicide are an epidemic in this country... I doubt there is a single person who isn't personally effected by these ailments, know someone who is or was. Four years ago, before I had started medical school, I remember feeling in a panic when I thought my friend had become depressed- I wasn't sure what classified as "depression" versus "feeling down", wasn't sure what were warning signs for suicide, or if talking about suicide in general to a depressed person was counter productive or helpful. 

I decided to list just a few things that I had "wished I had known" THEN, but most importantly things that I think everyone can know NOW, regardless of medical training. Perhaps if everyone knows a little bit about recognizing mental illness, we can get help for people earlier and true tragedy can be avoided.

So without further adieu, here are some basic mnemonics to remember:

(Medical school is basically learned through rote memorization, and mnemonics are always helpful to keep in your back pocket).

1. SIGECAPS - Diagnosis of Depression. To diagnose someone with depression, you simply need to remember the name SIG E. CAPS. If anyone has a depressed or extremely apathetic and has at least 5 of the 8 SIGECAPS questions, then they are diagnosed with depression.

  • S = Sleep --> can be more or less sleep
  • I = Interest --> losing interest in things you used to enjoy
  • G = Guilt --> feeling guilty for things you have no reason to feel guilty about
  • E = Energy --> less energy than normal
  • C = Concentration --> trouble concentrating on anything, like reading a book
  • A = Appetite --> either increased or decreased eating
  • P = Pyschomotor --> slowing of physical motions, usually perceived by others

S = Suicide --> thoughts of suicide *doctors are told to ALWAYS ask about suicide, friends and family members should too. You won't increase a person's likelihood of attempting suicide by asking- you will decrease it!

2. SAD PERSONS - Risk of Attempting Suicide. If someone appears clinically depressed and you are worried about suicide, there are some basic risk factors to keep in mind that might cue you in that someone is more likely to attempt suicide than others. 

  • S = Sex --> women are more likely to attempt, men are more likely to succeed
  • A = Age --> adolesents and elderly are at higher risk
  • D = Depression --> people with a prior diagnosis of depression
  • P = Previous Attempt --> people who have tried to kill themselves before 
  • E = Excess Alcohol (or other drugs) -->people are drunk or high or addicts
  • R = Rational Thinking loss --> this is typically a judgement call
  • S = Social Supports Lacking --> no family or friend support system
  • O = Organized Plan -->if the person has thought through a plan to kill themselves
  • N = No Spouse --> unmarried and single people
  • S = Sickness -->people in chronic pain, who have multiple medical problems, etc.

0-4 yes = lower risk, 5-6 yes = medium risk, 8-10 yes = high risk *obviously this is not always accurate, just a good screening tool

3.DIG FAST - Diagnosis of Bipolar Disorder. Feeling down or depressed is not exclusive to depression- and often people with bipolar disorder are considered just as high if not higher risk for suicide. Many times people in a "high" or manic state don't feel like they have any problems and don't go to friends/family/doctors for help until the depression hits... so it is important to figure out if in the past, they were ever manic, which would fit better with a diagnosis of bipolar disorder.

  • D = Distractibility --> distracted all of the time, easily frustrated
  • I = Irresponsibility or Indiscretion --> uninhibited - may go on a shopping spree or engaged in risky sexual behavior
  • G = Grandiosity --> feeling like you could rule the world, etc.
  • F = Flight of ideas --> thinking so fast it's hard to follow
  • A = Activity --> people in a manic state are highly productive, accomplish
  • S = Sleep --> requiring very little, or no sleep but still in a "hyper" state
  • T = Talkativeness --> "pressured speech", hard to follow

There is no better way to get a diagnosis and start treatment for mental illness than by encouraging the person to see their doctor, but having some tools in your back pocket helps as well! Hopefully these can be a start.

(Post by Stephanie Garbarino)

Posted on May 25, 2016 .