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Physical Symptoms of Depression: Unmet Needs

John F. Greden, MD

Published: April 1, 2003

Article Abstract

The burden of depression on society is sizable. Innate to this burden are underdiagnosis and undertreatmentof unipolar and bipolar major depressive disorder in all parts of the health care system inpart due to underrecognition of the physical symptoms that commonly are core components of majordepressive disorder. Physical pains especially complicate the diagnosis of depression. Many patientsde-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 ofdepression. Additionally, patients with residual physical and emotional symptoms following treatmentfor 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 anaccentuation 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 effectivelyfor initial episodes of depression and maintained after remission, individuals with genetic vulnerabilitiesmay experience a pattern of recurrences, cycle acceleration, and increased severity. Serotonin andnorepinephrine may be shared neurochemical links that tie depression and physical symptoms together.Thus, it is reasonable to hypothesize that antidepressants that incorporate both serotonin andnorepinephrine reuptake inhibition might be a more efficacious treatment approach for patients withphysical symptoms of depression.

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