Depression:  The Physical Pain & Symptoms

Sidney Kirchheimer he of WebMD discusses how medication may be ineffective for those with depression and chronic pain, where he explains that “Depression is a mood disorder diagnosed by tell-tale symptoms such as fatigue, lethargy, or poor sleep. But depression may manifest itself in physical aches and pains that offer no obvious cause, such as unexplained chest pain, muscle ache, trembling, or hot flashes”

Common Physical Complaints:

• Headaches or migraines
• Pains in lower and upper back
• Muscle aches and joint pain
• Pains in the chest
• Stomach issues
• Exhaustion and fatigue
• Sleeping problems
• Change in appetite or weight
• Dizziness or lightheadedness

Sidney describes how those with depressive symptoms are often not responsive to medication if they have physical complaints, and there are studies being conducted in order to better understand how and why this occurs.  He explains that “After studying 200 patients eventually diagnosed with depression . . . the Journal of General Internal Medicine [explains] that doctors often failed to make the initial diagnosis, instead misattributing their ill-defined physical symptoms to explanations other than depression. Therefore, no treatment was recommended for those who need[ed] it.”  Furthermore, “Even when a depression diagnosis was made, Keeley finds that patients with these physical symptoms were more likely to resist the use of the most-often prescribed therapy -- antidepressant medication -- because they didn't think they were depressed.”

Many people who are clinically depressed have difficulty believing their physical symptoms can be associated with a mental health issue, and it's easier for people to believe they have a physical illness than a mental health illness.  Part of it is the stigma associated with mental illness, and part of it is about wanting a quick cure.  In a society that can take a pill for most physical complaints, it would make sense that people would want a mental health issue to be a physical issue instead.  

Research

Sydney explains that the research "reports that those diagnosed with depression based on psychological symptoms were four times more likely to continue taking prescribed antidepressants for six months than those given the drugs based on physical maladies. “When polled, those with depression and physical ailments, have often complained that many are not satisfied with treatment, and to further prove the point of dissatisfaction or treatment failure with medication, Sydney explains that, “In that study, researchers found that nearly eight in 10 depressed patients are given antidepressant prescriptions and almost all had them filled. But within three months, many stopped taking the drugs. Many experts say that at least six to nine months of treatment -- sometimes longer -- is needed to best prevent a depression recurrence."

Since the 1990's the evidence has shown that patients with depression are more successful when matched to their preference of treatment.  An example described by Sydney explains that researcher Keeley believes "For instance, patients who have physical symptoms with no explanation appear to prefer a counseling approach as opposed to getting antidepressants."

The June issue of the British Journal of Psychiatry further supports these findings, where Dutch researchers report that at least one in six depressed patients seen by primary care physician had no medical diagnosis for their physical complaints or illnesses.  General practitioners in the Netherlands have no diagnosable general medical condition to account for their physical symptoms, and they are generally not linked with depression - The diagnosis is missed.

If a person is experiencing symptoms of physical pain or other abnormalities, it may be due to depression.  A doctor should ask questions about depressive symptoms with chronic complaints or any dramatic change in sleeping or weight, and it is important for doctors to look at all possibilities for pain complaints, which includes mental health issues. Some physicians may prescribe antidepressant medications, but they may also suggest other options such as counseling or a combination of medication and counseling.  Many studies have proven that medication and counseling can be very effective when combined.  Depression is a very real issue for many people, and if you or a loved one are experiencing symptoms, it is important to seek out professional help.  A professional therapist or psychiatrist can give an evaluation to determine if you or loved one meets criteria for depression. They can also help to provide treatment and resources to help manage and decrease symptoms of depression.

- Kim B.


Insightful Comments:


I have been a chronic pain sufferer for over ten years, because I was injured on the job and had a significant back injury, which required me to have surgery and post-operative physical therapy. 

I am not someone who likes to go to the doctor for any reason, and I usually have to be near death or dragged by my wife to a visit with the medical professionals. I will volunteer and encourage her to go on a very routine basis, but I resist at all costs. 

Sure I had been hurt before. Being hurt is different from being injured. Hurt is twisting your ankle playing ball, but continuing on. Hurt is slipping and falling and maybe even feeling sore the next day, but you still go to work. 

However, being seriously injured is different. Injury can be a temporarily or permanently debilitating accident that results in a broken leg that requires you to be off from work for an extended amount of time. An athlete that has an injury that puts them on the bench for a season or for the remainder of their playing career is serious, and this is what we all need to watch out for.

My original injury was scary. It was not from the incident, but from the resulting pain and inability to physically function. I was not myself. I could barely walk. I couldn’t drive. My wife had to help me dress and tie my shoes. It was frightening because I was unable to care for myself at an effective level. I had to rely on someone else, and that went against the core of my being.
My wife insisted that I seek treatment, so like a good husband I did what I was told to do when she took me to a doctor. The doctor advised me to seek further testing and then referred me to a surgeon who performed the procedure and  placed me on home restrictions before physical therapy began. I had six months of physical therapy before I was told I would never be as whole as I once had been, and I could no longer do the work I had been doing and became unemployed because of my injury.

What happened next?  I sank into depression. I could not sleep at the same time as my family, I often couldn’t be in the bed with my wife at the same time, and I was irritable and in almost constant pain. 

Eventually, I began to take on what menial tasks I could as my physical movements increased. They seemed to give me new hope and a sense of purpose. Through the movement and personal responsibility I was returning to a state of wholeness of mind and body. The more I was able to contribute, the less my pain and depression seemed to be. 

Did I have set backs? Certainly. There were times, and still are, that I have to take a break or even simply start a process over. Do I still suffer from the depression? Yes, from time to time - However, I am able to press-on I regain strength and purpose. 

Sources:

Body Aches May Signal Depression (http://www.webmd.com/depression/news/20040720/body-aches-may-signal-depression)
Sid Kirchheimer WebMD Health News July 20, 2004