HomeBlogPatientDepression and Physical Symptoms: For Patients, the Pain is Real Depression and Physical Symptoms: For Patients, the Pain is Real November 27, 2017Patient Patients who have depression may visit your practice and never say that they are feeling depressed. Typically, patients are more likely to respond with their physical symptoms when responding to the question, “What brings you here today?” In practice, these patients may share symptoms like: I’ve had this reoccurring backache, but have not had an injury. Why do I have diarrhea? I’ve not changed my diet. My neck and shoulders are constantly bothering me. Maybe it is why I’m not sleeping well? As a healthcare provider, it’s essential to uncover the root of these symptoms and determine if the patient’s complaint has a physical – or mental — cause. In his Physicians Postgraduates Press, Inc. article, “The Link Between Depression and Physical Symptoms,” Madhukar H. Trivedi, M.D. explains, “Physical symptoms are common in depression, and, in fact, vague aches and pains are often the presenting symptoms of depression.” Trivedi goes on to add that symptoms of depression-related pain and other symptoms can include: Aching joints and limbs Back pain Gastrointestinal pain or distress Insomnia Poor appetite, or other changes in eating habits According to Psychology Today: “In a study of over 25,000 patients at 15 primary care centers on five continents, Seattle researchers found that 50% of all depressed patients worldwide report multiple unexplained physical symptoms. It wasn’t that such patients were any less willing or able to express emotional distress. They readily acknowledged depressed mood when specifically asked about it.” How depression presents itself differs from patient to patient based on numerous factors, which can include three potential sources: a patient’s unique genetic makeup, a recognized depression-related trigger, or for a reason that’s not understood (called idiopathic depression). Why Depression & Pain are Linked Why do depression and pain frequently present together? According to the University of Michigan Depression Center: “Depression and chronic pain share some of the same neurotransmitters … as well as some of the same nerve pathways. Depression magnifies pain, changing the brain’s sensitivity to painful stimuli and reducing a person’s coping skills. And the constant stress of experiencing chronic pain can lead to a cascade of other medical problems linked with depression, making it still more difficult to break the cycle.” While pain and depression may be intrinsically linked, it’s not always clear that a patient presenting with physical symptoms may be experiencing depression. In the article “Does a Depression Intervention Result in Improved Outcomes for Patients Presenting with Physical Symptoms?” published in The Journal of General Internal Medicine, researchers studied 200 patients who were eventually diagnosed with depression. The study found that it could be difficult for doctors to discern when patients are dealing with depression when they originally come to the doctor for treatment of pain. “If you have stomach pain and there’s an ulcer, that’s an explanation for it. But often, physical ills occur for no apparent reason — and depression could be a likely cause,” said one of the study’s author Robert D. Keeley, MD, of the University of Colorado Health Sciences Center, to WebMD. “Yet unless they are specifically screened for depression, it’s hard for some doctors to pick up that it may be depression, especially in the primary care setting.” Screening for Depression Practitioners should screen patients for depression when they complain about pain. According to psychologist Dr. Elizabeth O’Connor, PhD, screening patients for psychological, emotional, and social distress is a critical part of modern medical practice for depression and physical wellbeing. A simple questionnaire can give insights into a patient’s background that might otherwise go unnoticed in the exam room. The American Psychological Association suggests using either the PHQ-9 or PHQ-2 in the primary care setting. Both tests are free and available in more than 30 languages. Creating a Treatment Plan Treatment plans can and should vary based on the individual patient. However, as the University of Michigan Depression Center points out, “medication is commonly employed to fight both depression and pain, since they share some of the same neurotransmitters.” Therapy can also help some patients. According to Psycom, Cognitive Behavioral Therapy can help patients manage chronic pain by addressing “anxious or negative thinking patterns and teach[ing] coping skills that reduce symptoms of both pain and depression.” Additionally, physical therapy can provide muscle relaxation, stretching exercises and low-impact cardio that may help alleviate symptoms. Finally, for some patients, healthcare practitioners may want to consider educating patients on how diet, stress management and healthy sleep habits can play an important part of a holistic treatment plan. Depression and physical symptoms may be linked, but they don’t have to be debilitating for your patients. Our articles are for informational purposes only and are reviewed by our Medical Information team, which includes PharmDs, MDs, and PhDs. Do not make any changes to your current medications or dosing without consulting your healthcare provider. The GeneSight test must be ordered by and used only in consultation with a healthcare provider who can prescribe medications. As with all genetic tests, the GeneSight test results have limitations and do not constitute medical advice. The test results are designed to be just one part of a larger, complete patient assessment, which would include proper diagnosis and consideration of your medical history, other medications you may be taking, your family history, and other factors. If you are a healthcare provider and interested in learning more about the GeneSight test, please contact us at 855.891.9415. If you are a patient, please talk with your doctor to see if the GeneSight test may be helpful. Patient Which Mental Health Provider Should I Consider? A Symptom-Based Guide The support of a good healthcare provider can make all the difference when you’re struggling with your mental health. But how do you connect to one in a sea of ... Read more Patient One explanation for why we experience Side Effects? Understanding Your Genetic Response to Antidepressants Antidepressants often play an essential role in helping patients with their mental health conditions. But as many patients can attest, it’s frustrating when... Read more Patient Barriers at Every Turn: How Systemic and Social Factors Block Men from Mental Health Care Taking the important step of seeking care for mental health isn’t always an easy decision. Uncertainty about the need for care, social stigmas associated wi... Read more Healthcare Provider Overcoming Side Effect Concerns: Leveraging Pharmacogenomic Insights to Inform Depression and Anxiety Medication Selection Whitnee Brown, a lifelong resident now practicing in Birmingham, Alabama has nearly an entire alphabet following her name, abbreviations for degrees and certifi... Read more Patient Concerns about Mental Health Medication Side Effects Remain a Barrier to Getting Help for Those Diagnosed with Depression and Anxiety Lisa Roberts has raised a family, reached an impressively high level in her career, and was an anchor for her mother and other family members. When, within ... Read more Patient Common Antidepressant Side Effects Taking an antidepressant can be an effective way to help treat a mental health condition like depression or anxiety. However, these medications can also cre... Read more Patient MTHFR Mutations: Clinical Implications and Management Strategies MTHFR mutations—changes in the methylenetetrahydrofolate reductase (MTHFR) gene—have gained increased attention in the medical community due to their potent... Read more Patient Can an App Help Me Manage My Anxiety? Health and wellness smartphone apps have become so common that if you can name a health goal, desire or condition, you can probably find an app for it. N... Read more Patient Black Trailblazers of Psychiatry and Mental Health: A Legacy of Healing and Advocacy As we celebrate Black History Month, we want to recognize a few individuals who have made extraordinary contributions to the field of psychiatry and mental heal... Read more Patient Mindful Moments: Tips for Anxiety If a well-meaning friend or family member has ever told you to “just breathe” when you’re feeling worked up or stressed out, you’d be forgiven if you felt l... Read more Learn more Learn more about GeneSight How to talk to your provider View our clinical studies
Patient Which Mental Health Provider Should I Consider? A Symptom-Based Guide The support of a good healthcare provider can make all the difference when you’re struggling with your mental health. But how do you connect to one in a sea of ... Read more
Patient One explanation for why we experience Side Effects? Understanding Your Genetic Response to Antidepressants Antidepressants often play an essential role in helping patients with their mental health conditions. But as many patients can attest, it’s frustrating when... Read more
Patient Barriers at Every Turn: How Systemic and Social Factors Block Men from Mental Health Care Taking the important step of seeking care for mental health isn’t always an easy decision. Uncertainty about the need for care, social stigmas associated wi... Read more
Healthcare Provider Overcoming Side Effect Concerns: Leveraging Pharmacogenomic Insights to Inform Depression and Anxiety Medication Selection Whitnee Brown, a lifelong resident now practicing in Birmingham, Alabama has nearly an entire alphabet following her name, abbreviations for degrees and certifi... Read more
Patient Concerns about Mental Health Medication Side Effects Remain a Barrier to Getting Help for Those Diagnosed with Depression and Anxiety Lisa Roberts has raised a family, reached an impressively high level in her career, and was an anchor for her mother and other family members. When, within ... Read more
Patient Common Antidepressant Side Effects Taking an antidepressant can be an effective way to help treat a mental health condition like depression or anxiety. However, these medications can also cre... Read more
Patient MTHFR Mutations: Clinical Implications and Management Strategies MTHFR mutations—changes in the methylenetetrahydrofolate reductase (MTHFR) gene—have gained increased attention in the medical community due to their potent... Read more
Patient Can an App Help Me Manage My Anxiety? Health and wellness smartphone apps have become so common that if you can name a health goal, desire or condition, you can probably find an app for it. N... Read more
Patient Black Trailblazers of Psychiatry and Mental Health: A Legacy of Healing and Advocacy As we celebrate Black History Month, we want to recognize a few individuals who have made extraordinary contributions to the field of psychiatry and mental heal... Read more
Patient Mindful Moments: Tips for Anxiety If a well-meaning friend or family member has ever told you to “just breathe” when you’re feeling worked up or stressed out, you’d be forgiven if you felt l... Read more