Depression and chronic mood disorders can manifest themselves through physical symptoms, said an expert at Baylor College of Medicine.
“It’s something that is very commonly seen,” said Dr. Sanjay Mathew, associate professor in the Menninger Department of Psychiatry and Behavioral Sciences at BCM. “Physical symptoms are what often drive a patient to see a primary care physician in the first place, and then with further questioning, the diagnosis of depression may emerge.”
Irritable bowel, chronic pain
Symptoms that may indicate depression include gastrointestinal syndromes such as irritable bowel or chronic pain conditions such as fibromyalgia, tension or migraine headaches. There also appears to be a lower threshold for pain in some patients with depression, Mathew said.
When physical symptoms occur, it may not be an either/or situation. Many patients will have diagnoses of both a physical illness as well as depression, since clustering of specific syndromes and illnesses can occur, said Mathew.
“In terms of figuring out what is part of the syndrome, we look at precipitating factors. Are there clear cut stressors? We know that emotional stress is a precipitant for many physical pain syndromes as well as depression,” said Mathew.
Take broad view
When it comes to treatment, it’s best to take a broad view and not focus just on the specific symptom, but put it in context of how much it is impacting a patient’s ability to function.
The first step is to get a complete medical history and physical exam from a primary care physician, said Mathew. It’s important to rule out any medical conditions before making a psychiatric diagnosis.
Certain types of antidepressant and anticonvulsant medications, medications that help treat seizures, also help with the physical symptoms of depression at low doses. This can help avoid polypharmacy, the use of multiple medications.
Mathew emphasizes that one should not ignore physical symptoms that may be connected to depression or a chronic mood disorder, but also advises not to rush to overly prescribe or treat the symptoms, as some of these symptoms may spontaneously remit.
Dipali Pathak
713-798-4710
pathak@bcm.tmc.edu
