PHYSICAL SYMPTOMS OF DEPRESSION: CAUSES AND TREATMENT

Depression, a prevalent mental health concern, is well-known for its impact on people's moods and behaviour. Changes to these can include feeling tired all the time, sleeping too much or not at all, loss of interest in daily activities, slowed thinking, feelings of worthlessness, etc. Often overshadowed by these emotional symptoms; however, depression is a complex mood disorder that can manifest as various physical symptoms like weight fluctuations, sleep disturbances, and gastrointestinal issues, to name a few, which can cause serious damage to our bodies.

In this article, we explore ways that depression can physically present in the body and different treatment options to manage these health outcomes effectively.

The Mind-Body Connection

It was previously believed that the mind and the body were separate entities. However, recent work provides evidence for a unity of the two, often called the "mind-body connection". This connection refers to the link between an individual's thoughts, attitudes, behaviours, and physical health.

Under this paradigm, the mind and emotions influence the body, and the body influences the mind. Further evidence for this bidirectional relationship is the strong communication networks between the brain and nervous system, endocrine system, and immune system, as well as organs and emotional responses. Thus, mental, psychological, and emotional experiences impact the development of illnesses. For example, chronic stress can cause physical reactions in the body, such as stomach ulcers or cardiovascular problems.

Depression and the Nervous System

As a response to stress, the body produces higher levels of adrenaline and cortisol - neurotransmitters involved in the stress response. In the short term, these neurotransmitters are adaptive in initiating the fight or flight response. Adrenaline, for example, constricts blood vessels, increases blood pressure, causes pupils to dilate, and slows digestion to promote action in response to the stressor. In the long term, however, chronically high levels of these chemicals can cause wear and tear on the body and organs, making an individual more susceptible to illnesses such as cardiovascular disease, stroke, diabetes, osteoporosis, and immune disorders.

In addition to their physiological role, neurotransmitters like serotonin and norepinephrine influence pain and mood, making them key players in the relationship between depression and physical symptoms. Low levels of these neurotransmitters are associated with depression, suggesting that their impact on mood may contribute to the development of the disorder. Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs) and dual-action antidepressants, target serotonin and norepinephrine to exert their therapeutic effects in treating depression. By regulating these neurotransmitters, these medications can help alleviate both emotional and physical symptoms of depression.

Brain-Gut Axis

The brain-gut axis - a bidirectional communication system between the central nervous system and the digestive tract - has been established as a strong contributor to physical symptoms of depression, linking digestive health to emotional and mental well-being.

The brain-gut axis encompasses the physical and chemical connections between the brain and the gut, including the numerous nerves and neurons. This communication system plays a fundamental role in various aspects of health, such as emotional and cognitive functions. As changes in the gut microbiome can lead to changes in mood and behaviour, the brain-gut axis is implicated in the physical symptoms of depression, including sleep disturbances, fatigue, pain, and discomfort.

Serotonin, a key neurotransmitter in mood regulation, also maintains digestive function. Most of the body's serotonin is produced and stored in the gut, emphasising the significance of the brain-gut connection in mental health and its potential impact on conditions like irritable bowel syndrome.

Understanding how the mind and body work together can encourage you to make lifestyle changes that can improve your physical and mental health. Addressing both emotional and physical symptoms is essential in taking a holistic approach to treating depression.

Physical Manifestations of Depression

Now that we understand the mechanisms by which depression and other mental health concerns can physically influence the body let's examine the most common ways depression manifests physically.

Sleep Disturbances

Depression has a significant impact on our sleep patterns. Insomnia and hypersomnia are the two most common sleep disturbances associated with depression, which can also cause physical pain in some individuals. More than half of individuals with depressive symptoms have difficulty falling or remaining asleep.

Sleep difficulty for any cause increases an individual's likelihood of developing mental illness, such as depression. This connection creates a vicious cycle, where sleep disturbances exacerbate depression, and depression, in turn, worsens sleep problems. Thus, addressing sleep disturbances becomes crucial in managing both emotional and physical symptoms of depression.

Fatigue and Lethargy

Depression can drain your energy, leaving you feeling tired and lethargic. This occurs through the modulation of neurotransmitters such as norepinephrine and histamine related to alertness and reward systems. As a result of the decreased neurotransmitter activity, individuals may feel more tired throughout the day. They may experience difficulty engaging in daily activities such as work, school, and social interactions. Low energy levels and decreased motivation caused by depression contribute to a negative cycle in which fatigue and apathy further exacerbate depression and its symptoms.

Lowered immune functioning

Individuals with depression are more susceptible to infections such as the common cold. While mild illnesses of the like may not be serious, long-term suppression of the immune system can lead to immune alterations, such as increased production of white blood cells. While white blood cells play a vital role in fighting disease, overproduction can suppress the immune system, increasing susceptibility to complex infections, inflammation, and immune system disorders. For example, an overproduction of white blood cells leads to a decline in natural killer cell activity, which destroys infected cells and cancerous cells in the body.

Cardiovascular Disease

Depression and stress are closely related. Often, individuals who are depressed are under a great deal of stress for a long period. Chronic stress and stress hormones contribute to high blood pressure and hypertension, putting your body in a prolonged state of emergency. Over time, this increases a person's risk of cardiovascular disease, including heart attacks and strokes.

Pain and Discomfort

Depression and physical pain share a complex relationship. Depression has been found to exacerbate bodily inflammation and heighten pain sensitivity, leading to symptoms like muscle aches and joint pain. As such, individuals with depression have been found to exhibit lower pain thresholds than individuals without depression. Moreover, individuals with depression are 60% more likely to experience back pain than those without depression. Moreover, increased pain, particularly chronic pain, can be associated with feelings of depression and hopelessness, as well as sleep problems. This interplay between depression and pain underscores the importance of treating mood and physical symptoms for a comprehensive approach to recovery.

Nutrition

Depression can lead to significant changes in appetite, which, if unchecked, can seriously impact nutrition, body weight, and physical appearance. Unintended weight gain associated with depression may cause long-term health issues such as diabetes or heart disease while being underweight can affect fertility, cause fatigue, and lead to malnutrition and cardiovascular problems. Moreover, over-or-under eating can also lead to the development of eating disorders in adults. Additional gastrointestinal issues associated with changes in eating patterns include:

• Stomachaches
• Cramps
• Constipation
• Nausea
• Irritable bowel syndrome

Sexual Dysfunction

Changes in mood and behaviour can cause people to lose interest in activities they once enjoyed, including sex. This can manifest as anhedonia, lack of arousal, having trouble maintaining an erection, experiencing pain during intercourse, or being unable to orgasm. Moreover, some prescription medications for depression can influence libido and affect performance. Impotence can affect one's confidence and self-image, just as low self-esteem, feelings of hopelessness, and fatigue can also lower your libido. A psychologist can help manage symptoms of depression as well as help increase libido.

Risk Factors and Vulnerabilities

Certain factors can increase the likelihood of experiencing physical symptoms alongside depression. Genetics, death or loss, biochemical factors, and other factors such as chronic illness and substance abuse may be associated with depression. Age, gender, and co-occurring conditions can also play a role in the presentation and severity of physical symptoms of depression.

Recognising these risk factors and vulnerabilities is essential in understanding and managing physical symptoms effectively.

Age

The prevalence of depression tends to increase with age, particularly among elderly individuals. However, rates of depression are lower in elderly men than in elderly women. Older adults, in general, are more prone to physical symptoms of depression due to other physical changes associated with ageing.

Gender

Gender plays a significant role in the manifestation of physical symptoms related to depression. Research indicates that women are more prone to physical symptoms of depression, including fatigue, sleep disturbances, and pain. Women are also more susceptible to depression due to hormonal fluctuations, such as during pregnancy or menopause.

Co-occurring Conditions

Co-occurring conditions refer to medical conditions that may intensify or contribute to physical symptoms associated with depression. The most frequent co-occurring conditions include anxiety disorders, substance abuse, eating disorders, heart disease, high blood pressure, stroke, chronic pain, and diabetes. Other co-occurring conditions, such as thyroid disorders, autoimmune diseases, and sleep disorders, can also play a role in the presentation of physical symptoms of depression.

Addressing these co-occurring conditions is essential for effectively managing physical symptoms of depression. This may involve the use of medication, lifestyle modifications, and therapy to treat both the depression and the underlying medical condition.

Managing Physical Symptoms

Coping with and reducing physical symptoms associated with clinical depression is essential for overall well-being. Implementing a combination of medication, lifestyle changes, and therapy can help alleviate these symptoms and improve daily functioning.

By addressing both emotional and physical symptoms, individuals can work towards a comprehensive approach to recovery.

Mind-body treatments for depression include meditation, guided imagery, progressive muscle relaxation, hypnosis, and autogenic training. Selhub concluded that using these techniques to balance the stress-response system can improve depression as long as no comorbid mental illness factors exist.

Medication

Antidepressants play a vital role in addressing both emotional and physical symptoms of depression. Dual-action antidepressants, such as venlafaxine and duloxetine, target serotonin and norepinephrine. Selective serotonin reuptake inhibitors (SSRIs), like sertraline and paroxetine, only affect serotonin reuptake. These medications help regulate neurotransmitters, alleviating both mood and physical symptoms.

Lifestyle Changes

Lifestyle modifications can significantly impact the management of physical symptoms of depression. Engaging in regular physical activity, consuming a nutritious diet, and obtaining adequate rest can help reduce fatigue, improve sleep and mood, and alleviate pain and discomfort associated with depression.

In addition to these changes, stress management techniques such as yoga, meditation, and deep breathing can also be beneficial in managing physical symptoms. Adopting a holistic approach that incorporates physical and emotional well-being can lead to more effective management of depression symptoms.

Therapy

Talk therapy, such as cognitive-behavioural therapy (CBT), interpersonal therapy, and mindfulness therapies, can be instrumental in addressing maladaptive responses to pain and other physical symptoms of depression and can help teach new coping skills. Therapy can assist individuals in recognising and addressing negative thought patterns that may contribute to physical symptoms of depression. Mindfulness therapies, in particular, can aid individuals in becoming more aware of their thoughts and feelings, fostering the development of new strategies for managing their pain. Incorporating talk therapy into a comprehensive treatment plan can help individuals better understand and manage both the emotional and physical aspects of their depression.

Treatment Challenges

Treating physical symptoms of depression can be challenging due to potential obstacles such as medication side effects. Recognising and diagnosing physical symptoms correctly is crucial to ensure effective treatment, as misdiagnosis can result in inadequate treatment and may even exacerbate symptoms. Overcoming these challenges is thus essential for successfully managing both emotional and physical symptoms of depression.

Side Effects

Physical side effects of antidepressant medications, such as nausea, weight gain, and sexual dysfunction, can impact treatment adherence. These side effects may discourage individuals from continuing their medication, potentially hindering their progress towards recovery.

If side effects become problematic, it is essential to discuss them with a healthcare provider, who may adjust the treatment plan to minimise side effects and ensure effective management of both emotional and physical symptoms. Open communication with healthcare providers and persistence in finding the right treatment can help individuals overcome these challenges and work towards recovery.

Diagnostic Difficulties

Accurate diagnosis of physical symptoms associated with depression can be challenging due to their similarity to symptoms of other medical conditions. Physical symptoms can be difficult to identify and may be easily overlooked, leading to misdiagnosis and inappropriate treatment.

To ensure accurate diagnosis, it is essential to be aware of the physical manifestations of depression and be willing to discuss them with a healthcare provider. Being truthful and comprehensive when discussing symptoms with a healthcare provider can help ensure the correct diagnosis and effective treatment plan, ultimately leading to better management of both emotional and physical symptoms.

Depression is as much physical as it is mental. Influenced by various factors like the brain-gut connection, individual differences in neurochemistry, and individual risk factors, each individual's experience with depression is unique. Recognising and addressing these physical and emotional symptoms is essential for a comprehensive approach to treating depression. By incorporating a combination of medication, lifestyle changes, and therapy, individuals can work towards managing their symptoms and improving their overall well-being.

The Kusnacht Practice is equipped to treat depression and its physical symptoms with health and care excellence, providing an array of specialised mental health therapies and treatments suited to each individual with Psychotherapeutic care, Medical treatment and care, Biomolecular Restoration and Rejuvenation (BIO-R®), and Family systems therapy. Our psychiatric and medical teams are dedicated to your well-being, providing personalised therapies tailored to your individual needs and goals. Whether it be to help manage symptoms of depression or other mental health concerns, our team is there to support you.

Consider getting in touch to find out how we can help.