Are you depressed? These 10 questions are a good test

Question: What types of screening tests are available for depression? What blood tests, X-ray tests, verbalization tests, written tests might help diagnose depression?

Answer: I believe you can't look at the physical health without looking at the mental health, and vice versa. Whenever I perform a complete history and physical examination, I always inquire about mental health — particularly when there are physical conditions that might predispose one to depression. Examples include chronic pain conditions such as arthritis or migraine headaches; hypothyroidism; menstrual problems; cancer; and heart disease. Treatment to improve one's physical health often, but not always, leads to an improved sense of well-being and improvement in one's mood.

While there aren't specific blood tests to measure brain chemical neurotransmitter levels or imaging tests to pinpoint depression, a number of depression screening tests have been developed over the years. Many can be found through a Google search.

I have developed my own screening questions:

1. On a scale of 1 to 10, with "1" feeling very happy and "10" feeling like you wish your life were over, how would you rate your mood?

2. On a scale of 1 to 10, with "1" feeling very calm and "10" feeling so anxious you could crawl out of your skin, how would you rate your anxiety?

3. How would you rate your concentration — good, fair, poor, or in between?

4. How would you rate your motivation — good, fair, poor, or somewhere in between?

5. Do you have increased irritability?

6. Do you have increased crying spells?

7. Are you stress-eating?

8. Do you have a decreased interest in enjoyable activities?

9. Do you have difficulty falling asleep? (A red flag for anxiety.)

10. Do you have trouble staying asleep? (A red flag for underlying depression.)

This provides both the patient and the doctor with a measure of mental state that can be remeasured and compared after an antidepressant is started.

Q: Even though I've never had an attack of gout, my family doctor wants to put me on the drug Allopurinol because my blood showed a high uric acid level of 8.4. Do you recommend I take it?

A: It all depends upon your medical history. The teaching for years has been that unless a person has had gout attacks, treatment to lower uric acid blood level is probably unwarranted. However, several recent studies have looked at whether an elevated uric acid level might be deleterious to the health of people with other medical conditions such as cardiovascular and peripheral vascular disease, high blood pressure, diabetes, high cholesterol, stroke, and chronic kidney disease. Research has shown that uric acid can act as a pro-oxidant to the lining of blood vessels (a phenomenon analogous to rusting) and promote dysfunction of the cells that line arteries, leading to less release of artery-dilating nitric oxide. A high blood uric acid level also causes thickening of the artery walls that supply blood to the kidneys, and promote the release of inflammatory substances into the bloodstream.

Is uric acid involved in all factors for cardiovascular and kidney disease? Current thinking is that it is. Therefore, treatment to reduce a blood level of uric acid to less than 6.0 is probably warranted in higher-risk populations.