The article you requested is
Physical Symptoms of Depression: Unmet Needs
J Clin Psychiatry 2003;64(suppl 7):5-11
© Copyright 2014 Physicians Postgraduate Press, Inc.
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The burden of depression on society is sizable. Innate to this burden are underdiagnosis and undertreatment
of unipolar and bipolar major depressive disorder in all parts of the health care system in
part due to underrecognition of the physical symptoms that commonly are core components of major
depressive disorder. Physical pains especially complicate the diagnosis of depression. Many patients
de-emphasize psychosocial symptoms while emphasizing pains as their primary or sole complaints.
There is a high correlation between the number of physical symptoms reported and the presence of
depression. Additionally, patients with residual physical and emotional symptoms following treatment
for depression appear to be at higher risk of relapse compared with those who have no residual symptoms.
Complex genetic vulnerabilities underlie the depressive diathesis, and stress appears to be an
accentuation for the gene expression that sets off episodes of depression in persons with these predispositions.
If underdiagnosis interferes and acute treatment is not implemented early and effectively
for initial episodes of depression and maintained after remission, individuals with genetic vulnerabilities
may experience a pattern of recurrences, cycle acceleration, and increased severity. Serotonin and
norepinephrine may be shared neurochemical links that tie depression and physical symptoms together.
Thus, it is reasonable to hypothesize that antidepressants that incorporate both serotonin and
norepinephrine reuptake inhibition might be a more efficacious treatment approach for patients with
physical symptoms of depression.