The emotional and cognitive symptoms of Depression co-occur with severe physical symptoms. Four of the nine diagnostic criteria for Depression are physical: changes in sleep, weight, psychomotor abilities and physical fatigue1. Those with Depression can be three to four times more likely to experience comorbid psychomotor, musculoskeletal and inflammatory diseases1. Although the two predominant symptoms involve mood and cognition, physical symptoms can be easier to observe. Therefore, they may be more useful in noticing a depressive episode in yourself or someone else. Research suggests that depression is the result of a combination of biological, physiological and social factors. Recently more attention has been paid to the co-occurrence of physical and psychological symptoms of depression. It's well known that the physical and psychological symptoms of depression exacerbate each other, for example, physical fatigue stop someone from engaging in activities that boost their mood. Recently research has linked the co-occurrence of the psychological and some of the physical symptoms of depression to dysregulation of neurotransmitters (serotonin and norephedrine) and inflammation in the body2.
A symptom of Depression is a change to regular sleep patterns experienced most days for more than two weeks. This can either be increased (Hypersomnia) or decreased (Insomnia) hours of sleep as well as difficulties breathing during sleep (Obstructive Sleep Apnoea)3. It’s estimated that 75% of adults with depression also experience insomnia4. Notably, those with hypersomnia often don't feel rested even after a long period of sleep. Another symptom of Depression is feeling fatigued or a loss of energy most days for at least two weeks. This is likely due to the dysregulation of serotonin and norephedrine, amongst other factors5. Many antidepressants assist in the release of serotonin and some additionally affect norephedrine. Serotonin is associated with calm, sleep and mood regulation whereas norepinephrine with attention and energy levels.
There are many reasons for weight changes including aging, hormones and lifestyle factors. For those with depression weight changes can occur for multiple reasons6. Firstly, changes in mood and stress that leads to depression can change dietary and exercise habits. People often eat excessive or unhealthy food in response to low mood or distress. Those with depression also lose motivation and interest in previously pleasurable activities, especially those with a delayed reward-like exercise. This combination paired with irregular sleep patterns often leads to fluctuations in weight. Everybody is different and depression manifests differently. Those with predispositions around disordered body image and food may start to lose weight, which is also highly correlated with depression. Unfortunately, some anti-depressants prescribed for depression can cause weight gain. Luckily there are many types of antidepressant treatments with differing side effects.
Another symptom of depression is psychomotor retardation or agitation. This involves changes in movement and speech: Speech typically becomes slower, with more pauses, lower volume and less expressivity; Gross body movement of the limbs, torso and head is slowed; Eye movement becomes more static and eye contact is less frequent; Posture tends to be more slumped7.
Those with depression are more likely to experience specific and general physical pain that has no other medical cause2. They also tend to have a lower pain tolerance and threshold8. It's theorised that this is due to dysregulation of neurotransmitters and/or because of increased inflammation. Research suggests that inflammation is a contributing factor to depression and its resulting fatigue and pain. Those with depression frequently report headaches, back and neck pain. Women with depression may experience more severe period pain as well.
People with depression often identify their physical symptoms before their psychological ones. If someone goes to their doctor for physical symptoms it can be upsetting to hear it's caused by a psychological issue9. People tend to interpret this as 'all in their head' and not real. For those with depression, who often experience unnecessary guilt and shame, this idea can reinforce feelings of unworthiness and hopelessness towards the possibility of recovery1. Yet psychosomatic symptoms are real and can be just as severe as those that stem from diseases in the rest of the body2. The public perception of psychosomatic symptoms stems from the same bias that made amputation and physical scarring easier to discuss than Shell Shock (PTSD) in World War 1 and 2. Psychosomatic symptoms are more common in cultures where mental health is a taboo10. It’s often theorised that when internal distress is not able to be expressed in healthy ways it is forced to present in physical problems. The research into psychosomatic symptoms is challenged because it can present itself in vastly different ways depending on the person.
The symptoms of depression stretch far beyond the psychological. Often physical symptoms can be easier to spot at the beginning of a depressive episode. Despite public bias against psychosomatic symptoms, these are just as valid and significant in recovery from depression. For someone without a history of depression, I considered myself well informed about the symptoms and pain that it can cause. Writing this article has opened my eyes to the many ways in which it can affect a person’s life. My respect for anyone who works their way through this disorder has doubled.
If you or someone else needs help with their Depression or other mental health difficulties, please contact us at 9809 1000 or submit an online enquiry here.
Suite 12, 129A Lake Street Cairns Qld 4870
1300 088 444
1300 088 444
deneen@7stagesofhope.com
