The problem with depression and anxiety tests

IMPORTANT DISCLAIMER: I AM NOT LEGALLY TRAINED TO GIVE ADVICE – INFORMATION IS PROVIDED AS IS – DO NOT STOP TAKING MEDICATION WITHOUT TALKING TO YOUR DOCTOR OR PSYCHIATRIST FIRST!

So this has been on my mind for a while. Now I actually want to talk about it.

I’ve had depression and anxiety since age ten

Possibly even earlier, I never fit in. I was bullied. I wanted to never go to school quite early on. I was also frequently sick due to just generally due being a child, but there were days where I just couldn’t go to school.

In spite of the overwhelming evidence that I had both depression and anxiety from a young age. The most common treatment for a child during my time was to “toughen up”, to “be a man”, to “stop complaining”, and to stop “being a hypochondriac”.

It was 16 years before I was officially diagnosed with depression, at 26. It was a further seven years after that before being diagnosed with anxiety at 33.

But this wasn’t the problem… I had underlying things – things I didn’t fully discover until I was 37.

Misdiagnosis of co-occurring neurodivergence

For those of us diagnosed as adults, I had noticed a lot of people talking about how before they had been diagnosed for ADHD or autism, they were diagnosed for depression, anxiety, or both for a long time before hand.

I ran an unscientific poll using popular hashtags on Twitter for ADHD or autistic people. I estimated around 80% of us would have had these diagnoses first. The result was 87.4%.

The co-occurring depression and anxiety one is probably the biggest red flag that doctors really need to pay attention to.

But I started to wonder – why weren’t these detected by doctors?

Depression/Anxiety tests are awful

I’m not sure what the standard is elsewhere – but when I was tested for depression because I told the doctor I was depressed they gave me this test (Developed with funding by Pfizer – A pharmaceutical manufacturer)

A scale test with items rated from 0-3 from not at all to nearly every day for experiences in the last two weeks:


Having little interest or pleasure in doing things 

Feeling down, depressed, or hopeless

Having trouble falling or staying asleep, or sleeping too much

Feeling tired or having little energy

Having a poor appetite or overeating 

Feeling bad about yourself — or that you are a failure or have
let yourself or your family down

Having trouble concentrating on things, such as reading the
newspaper or watching television 

Moving or speaking so slowly that other people could have
noticed? Or the opposite — being so fidgety or restless that
you have been moving around a lot more than usual

Having thoughts that you would be better off dead or of hurting
yourself in some way

This is apparently a highly reliable diagnostic test and one that is used commonly to assess patients before giving them anti-depressants in most cases.

Now onto the most commonly used anxiety test (This again was developed with funding from Pfizer)

A scale test with items rated from 0-3 from not at all to nearly every day for experiences in the last two weeks:

Feeling nervous, anxious, or on edge

Not being able to stop or control worrying

Worrying too much about different things

Trouble relaxing

Being so restless that it's hard to sit still

Becoming easily annoyed or irritable

Feeling afraid as if something awful might happen

Here’s the massive problem I have with it.

It never asks why you are feeling this way, in either test.

I’m not sure if it’s the same everywhere – but in New Zealand we have 15 minute appointment times to get all our health concerns addressed. That’s a remarkably small amount of time to talk to someone about your health issues.

These on our Ministry of Health website say not to use them for diagnostic purposes and that only a health professional can do it. The health professional in my case only asked these questions – so I am not sure how I was diagnosed if that was the advice.

The problem of pathology without context

The big problem I have here is that while anxiety and depression are things in their own right, they can also be a response to things in your life that are perfectly reasonable to be depressed or anxious about.

But instead – the way this works is that it instantly frames you as the problem – you are an anxious or depressed person – you need to take this medication because you are broken – this is YOUR fault.

I internalised a ton of ableism from this – I thought my external concerns were invalid – growing up in masculine culture really didn’t help here. I was “weak” and I needed pills to make me strong – I was broken, and only the meds could fix me.

Except they didn’t… It was actually underlying ADHD, autism and OCD that I had to discover entirely independent of the profession that was supposed to diagnose these things first.

A new approach for mental health for doctors

The mental health approach for doctors must change – they must dig deeper into root causes, it’s not enough to talk about scales, you must get to know your patients life. You must consider every alternative rather than the one the patient is most educated about – because the patient doesn’t have your education, and if you don’t have enough details about mental health diagnoses and current science – it’s on you to read up and upskill.

Medications have a place they work for a lot of people – and that’s important to remember too!

I’m personally skeptical of medications for me

In my case they never worked – they did give me a whole heap of other side effects including weight gain, dissociation, rebound effects, serotonin shock syndrome, lightning zaps in my body, and insomnia from one particularly bad one.

I ended up having a significant mental health breakdown before identifying my co-occurring autism and OCD, despite taking drugs to treat my anxiety and depression.

The thing that has helped me most that I truly believe, is having the correct names for the things I was struggling with. I still get anxiety and depression but I know the cause of them now – and when I know they are not random and are explainable – I can deal with them on my own, without medication as my own personal choice.

Conclusion

Anxiety and depression tests do not tell the full story most of the time. They made me internalise guilt a lot for feeling like I was wrong for feeling anxiety and depression, but the second I had names for the reasons why I felt like this – the second their power over me stopped taking hold.

I have self-esteem now, I don’t think I’m crazy. I was just misdiagnosed for so long, I never knew what was wrong with me. That can’t and should not ever happen to other people.

Published by roryreckons

I am an ADHD/Autism Coach as well as ADHD/Autism/OCD/CPTSD advocate and independent ADHD/Autism researcher. I am an ADHD/Autism Coach who trained through the ADD Coaching Academy. I write mainly about ADHD/Autism/OCD/Mental health issues, but will also discuss morality, abolition, and current affairs occasionally.

One thought on “The problem with depression and anxiety tests

  1. I’ve yet to find a questionnaire on mental illness or neurodivergence I didn’t take issue with, but the anxiety and depression ones most commonly used are particularly aggravating. This is the one used by GPs in Australia to evaluate you for a “mental health care plan” https://www.beyondblue.org.au/the-facts/anxiety-and-depression-checklist-k10

    “About how often did you feel tired out for no good reason?”
    The first question and to me the most laughable in the baggage it contains yet expects a simple numerical scale answer. If I’m strict with “no good reason” it’s rarely, even though I’m tired the vast majority of the time. But since that’s arguably due to my lack of sleep/bad sleep schedule, well. However the reason it’s like that isn’t external, it’s a symptom of my issues.

    Honourable mentions to this question too
    “About how often did you feel so sad that nothing could cheer you up?”
    How am I meant to know when I’m so sad nothing COULD cheer me up if I’m not on some dogged mission to seek out things to cheer me up? Does this hypothetical include things out of my control, e.g. unexpected announcement of great news? Does “cheering up” mean experiencing joy/happiness? Because I don’t think I often experience that even when I’m not actively sad. Or does it just mean becoming less sad? Then that’s too low of a bar.

    Honestly the only reason I can answer these at all is I was good at school. I would ask for clarification on questions that had what I saw as deep ambiguity, so over time I understood what things were “really” asking for in context. It didn’t matter that I could make as good an argument for C being the correct answer as B, if B was the most obvious and what “normal” people would see as the clear choice.

    Still, I think I always err to understatement on these cognitive quizzes. It feels more honest to me, even though I know the NT evaluator is probably getting a less accurate personal impression. “About how often did you feel worthless?” I put “most of the time” instead of always not because I can ever recall feeling truly worthy, but I don’t spend every moment feeling actively worthless.

    Like

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