Depression: 9 physical symptoms that «scream» and should not be ignored

Physical symptoms are quite common in many different medical conditions. They are the most important elements that enable clinicians to differentiate the patient's clinical condition from conditions with other symptoms.

In general, they are associated with a lower quality of life, increased use of various health services, and increased psychological distress. stress.

They are very common in various well-known physical illnesses, such as cancer, heart disease, etc., but they are also present in psychiatric conditions, such as mood disorders, anxiety disorders, and somatic disorders.

In terms of their location, they are classified into four categories:

1. cardiopulmonary,
2. gastrointestinal,
3. pain, as well as
4. general physical symptoms.

To introduce physical symptoms in depressive disorders at this point, it is important to emphasize that depression more than any other mental illness, affects the entire body.

Along with anxiety disorders, it is considered the most important predictor of overall health, in the sense that it can predict the course of both existing physical illnesses and the development of new ones.

Physical symptoms are usually combined with mental symptoms, constituting manifestations of them, in the sense that they either worsen or improve depending on the course of the depressive symptoms.

Finally, in rarer cases, there may be subclinical or atypical depression, where physical symptoms are the only ones that reveal the very existence of the disease.

Let's first look at the mechanisms involved in the creation of physical symptoms in depression, as well as the link between physical symptoms and the subsequent onset of depressive disorder.

Disorder of the nervous system

The acid stress activates the sympathetic nervous system and deactivates the parasympathetic nervous system, a mechanism that has been called the «fight or flight response» and is a normal reaction of the body.

However, it has been found that during periods when stress is sustained for longer periods of time and/or is combined with depression, this autonomic activity is disrupted.

We can monitor autonomic activity by monitoring the levels of catecholamines in the blood plasma, i.e., norepinephrine and its metabolites.

It has therefore been found in relevant studies that depression is a process that tends to increase sympathetic activity more steadily and reduce parasympathetic activity, resulting in the individual becoming stressed even when the stimulus is not anxiety-provoking.

Metabolic disorders

Any metabolic disorder can lead to the development of diabetes, obesity, heart disease, cancer, or cognitive impairment. A review of studies by Pan et al. showed that depression and metabolic syndrome are linked, as the former may be a precursor to the latter.

The disorder is located in adipose tissue, specifically in the abdominal area. This tissue produces various cytokines associated with the onset of depression and metabolic syndrome. Another possible cause is related to damage to the endothelium of blood vessels, which is associated with metabolic syndrome and the onset of depression.

Dysfunction of the Hypothalamus, Pituitary Gland, and Adrenal Glands

This system (hypothalamus-pituitary-adrenal glands) is one of the best known systems in the human body, and its activity is considered one of the most important mechanisms in the development of depressive symptoms.

It involves the activation of the cerebral cortex, which, due to chronic stress, in turn activates the hypothalamus, where the corticotropin-releasing hormone is produced, which in turn activates the pituitary gland, which finally activates the adrenal receptors and releases cortisol into the blood.

Various studies have shown that patients with depression have consistently elevated levels of cortisol in their blood, and various hypotheses have been proposed to explain this phenomenon.

The hypercortisolemia present in a depressed patient may be related to a change anywhere in the hypothalamic-pituitary-adrenal system.

Immune system disorder

Several recent studies have highlighted the importance of inflammation in depressive disorders.

Specifically, depression has been found to be associated with disturbances in the inflammatory process, a

immune response that begins with the activation of the immune network of inflammation.

Various molecules play a role here, the most important being the pro-inflammatory cytokines Interleukin-1 and

Interleukin-6 (IL-1, IL-6), tumor necrosis factor TNF, etc., which produce inflammatory

cells in response to immune exposure.

There are other cytokines, such as Interleukin-10, which exhibit anti-inflammatory properties.

action and oppose the immune response through various molecular mechanisms.

The first studies correlating inflammation and depression began in 1991, with increased rates

inflammatory markers are found in depressed patients, while recent findings from

clinical studies demonstrate the link between depression and various other immune disorders.

mechanisms such as molecular mechanisms at the cellular level.

Now that we have seen the mechanisms behind the development of physical symptoms of depression, let's take a look at what these symptoms are.

1. Chest pain/heaviness:

very characteristic of panic disorder, but also of depression, with the individual often feeling «choked» and having difficulty breathing. It is important to rule out organic causes, as pain with similar characteristics occurs in heart disease, stomach ulcers, and lung disease.

Finally, it is important to note that people with a history of heart disease often experience some form of depressive disorder at some point.

2. Headaches/myalgia/chronic pain

not classified elsewhere chronic pain, can often be the result of chronic subclinical depression or dysthymic disorder. The same applies to chronic muscle and joint pain, headaches, and migraines. Particularly for migraines, a significantly increased rate of depressive disorder has been found in the future. 

It is important to note here that it is quite common for symptoms of pain/chronic pain to escape the attention of both the social environment and the individual themselves, as they are often attributed to personality traits («he was always complaining,» «he always says he's in pain to get attention,» etc.).

3. Disorders of the GES

The gastrointestinal system is severely affected by depression, as it is linked to the brain receptors (serotonin) responsible for depression. The patient may experience anything from simple discomfort and bloating to vomiting, nausea, and diarrhea.

4. Sleep disorders

In the typical form of depression, symptoms such as insomnia appear, with delayed onset and/or interruptions during sleep and/or early awakening (usually one of the three occurs). In the atypical form of the disease, however, these characteristics may take the form of hypersomnia with many hours of sleep, great difficulty in waking up in the morning, and reduced energy.

5. Eating disorders

Appetite is typically reduced in classic depressive episodes, but may increase in atypical forms. Eating disorders such as binge eating, bulimia, and anorexia may also occur. If these remain to the extent that they meet the criteria for an eating disorder, then we are talking about depression with an eating disorder.

6. Sexual dysfunction

Sexual desire and libido are significantly reduced in a patient suffering from depression. They may even have disappeared completely.

7. Hypothyroidism:

It is important to mention the correlation between thyroid disorders and emotional symptoms, whether these take the form of manic episodes (in hyperthyroidism) or depression (in hypothyroidism). Thyroid gland testing is a basic laboratory test that needs to be performed in all psychiatric conditions, especially emotional disorders.

8. Unexplained physical fatigue

If physical fatigue is not associated with any physical or organic factors (physical: lifestyle, reduced sleep, etc./organic: anemia, physical illness, hypothyroidism, etc.), it is very likely to be due to the chronic inflammatory process that occurs in cases of chronic mental stress and depression.

9. Worsening of illnesses

Starting with a simple condition, such as a common cold that takes a long time to recover from, to more systematic conditions that take a turn for the worse. Studies have found that the coexistence of depression generally reduces recovery by a significant percentage, through the immune and neuroendocrine mechanisms discussed above.