Depression has many different symptoms. According to the National Institute for Mental Health, the symptoms may include the following:
- Persistent sad, anxious, or “empty” mood
- Feelings of hopelessness, or pessimism
- Feelings of guilt, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Decreased energy or fatigue
- Moving or talking more slowly
- Feeling restless or having trouble sitting still
- Difficulty concentrating, remembering, or making decisions
- Difficulty sleeping, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Aches or pains, headaches, stomach cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment
Many people have depressive symptoms that affect their physical bodies and well being on some level. In fact, physical symptoms are thought to occur in about 50-90% of depressed patients!
According to researcher M. H. Trivedi the physical symptoms can involve:
chronic joint pain, limb pain, back pain, gastrointestinal problems, tiredness, sleep disturbances, psychomotor activity changes, and appetite changes.
A high percentage of patients who seek treatment in a primary care settings report only physical symptoms, which can make depression very difficult to diagnose.
Depressed people with physical symptoms are more likely to:
- be severely depressed
- have nonremitting depression
- be at risk for depression relapse
- have complex symptoms
- be difficult to treat
- have other psychiatric comorbidities
- have poor treatment outcomes
- lose work productivity
- require polypharmacy(Translating Evidence on Depression and Physical Symptoms Into Effective Clinical Practice, 2004.)
Here are the various ways being clinically depressed can also be physical.
Back pain and body aches
Symptoms of chronic body aches, and/or back pain are common especially when it comes to more severe depressions. A community study in Canada found that only 5.9% of respondents without back pain had major depression but in comparison, 19.8% of respondents with chronic back pain had major depression (Currie and Wang, 2004).
A study in the Journal of Pain in 2004, found that migraine and depression are strongly linked to each other. People with depressive symptoms are also more likely to get tension headaches more frequently (Janke et al).
Stomach and digestion
Depression can affect a person’s eating habits in many ways. Some people binge eat, overeat or eat unhealthy fatty or sugary foods and can become obese or even develop diabetes — strangely enough, other sufferers can have an utter lack of appetite, can even lose unhealthy amounts of weight or suffer from malnutrition. Depression can also cause stomach upset, constipation, diarrhoea and other digestive issues.
Serotonin, is well known as a brain neurotransmitter but it also has a connection to our gut. It’s estimated that 80-90 percent of the body’s serotonin is made in our digestive tract and it’s largely responsible for regulating intestinal movement and involved in our sensitivity to and regulation of pain. People with depression/anxiety often are susceptible to Irritable Bowel Syndrome and “some research suggests that IBS patients who suffer mainly from diarrhea may have increased serotonin levels in the gut, while those with constipation-predominant IBS have decreased amounts” (Harvard Health Publications).
Heart disease and depression are intricately linked and medical science and psychology are just beginning to understand the connection. According to Harvard Medical School, patients with depression, when hospitalised for a heart condition, are 2 to 5 times more likely to have severe angina, heart attack, or stroke, in the next year. On average depression is reported in an about 10 percent of adults and rises to about 30 percent for heart attack patients. This points to a definite connection between depression and our heart. As to why depression can harm our heart? It’s thought that it affects the action and levels of our stress hormones like adrenaline, norepinephrine and cortisol and also affects blood pressure and heart rate, which can all affect the health of our cardiovascular system (Harvard Mental Health Letter, 2016).
Fatigue and exhaustion
Perhaps the most common physical symptom for those who are depressed is feeling high levels of fatigue and exhaustion after doing ordinary daily activities. This is a classic physical symptom of being depressed and often keeps sufferers from being able to develop a successful routine of life. It’s very hard to meet the challenges of life when you have no energy.
Why do we have physical symptoms?
Many people ask, how can there be physical symptoms if depression is something that takes place in our brains?
The short answer is that depression is a complicated disorder that involves biological/physical, environmental, social and psychological factors. Much more complicated than just feeling blue.
The reality is that it is a disease that is physical, a real and tangible medical disorder, it’s not just getting the blues — and the existence of physical symptoms really proves this out.
Many of the physical symptoms are thought to possibly be caused by miscommunication or malfunctioning in the neural pathways that extend from our brainstem to our spinal cord and then throughout the rest of our nervous system. As well, possible malfunctioning and imbalances of the neurotransmitters, dopamine, norepinephrine and serotonin, the drugs targetted by antidepressants, may also contribute to both pain & depression.
When it comes to treating depressed patients exploring the physical symptoms is very important. In fact:
Many physicians consider a patient to be in remission from depression when his or her acute emotional symptoms have abated, but residual symptoms, including physical symptoms, increase the likelihood of relapse. (Trivedi 2004)
So what do you need to do to start to feel better?
1. Get a full physical to rule out other possible causes for the physical symptoms.
2. Develop a healthy diet and physical exercise routine.
Even walking for 20-30 minutes a day can reduce both pain and depression symptoms. Additionally, “Being overweight can contribute to pain. Try to reduce portion size, increase intake of fruits and vegetables, shift away from red meat and saturated fats, and shift toward foods with more omega-3 fatty acids such as coldwater fish and plant sources of fat”. (Translating Evidence on Depression and Physical Symptoms Into Effective Clinical Practice., 2007).
Paradoxically, sometimes increasing exercise levels can even help people feel less fatigue and more energy!
3. Develop better “coping skills”.
How do you think about your depression and pain? Do you see it accurately? Or is there a tendency to think very negatively? Here’s a great link to an online self-help workbook to improve your coping skills:
4. Develop stress reduction strategies:
Alleviating stress also seems to reduce pain. Activities like yoga, meditation, and other “mind-body” approaches may help with both the emotional depressive symptoms and pain management.
Here’s a link to some basic stress management strategies:
5. Be kind to yourself & practice better self-care:
Here’s a link to some self-care tips:
6. Finally, consider a course of psychotherapy with a psychologist to explore all of the symptoms and ways to improve your life. Perhaps even find a psychologist that deals especially with pain and pain management?
This blog is not intended as medical advice, treatment or diagnosis and should in no way replace consultation with a mental health or medical professional.
Currie WR, Wang J.. Chronic back pain and major depression in the general Canadian population. Pain. 2004;107:54–60.
Janke EA, Holroyd KA, Romanek K. Depression increases onset of tension-type headache following laboratory stress. Pain. 2004;111(3):230-238. doi:10.1016/j.pain.2004.06.007.
Trivedi, M. H. (2004). The Link Between Depression and Physical Symptoms. Primary Care Companion to The Journal of Clinical Psychiatry, 6(suppl 1), 12–16.
Targum SD, Fava M. Fatigue as a Residual Symptom of Depression.Innovations in Clinical Neuroscience. 2011;8(10):40-43.
American Heart Association How does depression affect the heart? (2016) http://www.heart.org/HEARTORG/HealthyLiving/StressManagement/HowDoesStressAffectYou/How-does-depression-affect-the-heart_UCM_460263_Article.jsp#.WDNd4KIrI6g
Harvard Mental Health Letter. 2016 Depression and Heart Disease : Mind and mood affect the heart http://www.health.harvard.edu/press_releases/depression_and_heart_disease
Understanding and treating an irritable bowel Harvard Health Publications http://www.health.harvard.edu/staying-healthy/understanding_and_treating_an_irritable_bowel
Translating Evidence on Depression and Physical Symptoms Into Effective Clinical Practice. (2007). Primary Care Companion to The Journal of Clinical Psychiatry, 9(4), 295–302.