Depression physical complaints

Patients with depression usually do not present initially to mental health professionals. Most visit their primary care physicians, complaining not of depressed mood but of other symptoms of depression. Fatigue, insomnia, loss of appetite, loss of interest in sex, muscle tension, body aches, and poor concentration are all commonly reported. These so-called masked presentations of depression may in part explain the documented failure of primary care physicians to diagnose depression reliably. This underscores the importance of considering depression in the differential diagnosis of physical complaints that appear vague or exaggerated. 

Primary care physicians are critical to the successful identification of GAD. Characterized by often-vague physical complaints, GAD must be distinguished from medical illnesses and other psychiatric disorders, though the high rate of comorbidity requires that a thorough evaluation for GAD be completed even when another disorder has been identified. GAD warrants particular consideration for those patients with nonspecific physical complaints who nevertheless have an urgent need for relief that has resulted in repeated office visits. The differential diagnosis for GAD includes other anxiety disorders, depression, and a variety of medical conditions and substance-induced syndromes. 

Antidepressants are medications used to treat depression, i.e. states of severe dejection lasting for weeks or months. The term depression does not designate a single disease but a syndrome that needs to be characterized more precisely on the basis of the prevailing symptoms present and taking the patient s prior history into account. On the basis of the patient s clinical status, differentiation is made between inhibited and agitated forms of depression states of depression that are almost exclusively expressed in the form of physical complaints and symptoms are also termed somatized or masked depressions. 

Alai con FJ, Isaacson JH, Franco-Bronson K (1998) Diagnosing and ti eating depression in primai y cai e patients Looking beyond physical complaints. Cleve Clin J Med 65 251—260. 

Depression in the elderly is a major public health problem. Many elderly depressed patients are often inadequately treated, or depression is missed or mistaken for another disorder, such as dementia. In the elderly, depressed mood, the typical signature symptom of depression, may be less prominent than other depressive symptoms such as loss of appetite, cognitive impairment, sleeplessness, anergia, and loss of interest in and enjoyment of the normal pursuits of life. Somatic (physical) complaints are quite frequently the presenting symptoms in elderly depressed patients. The increased suicidal attempts present in the depressed elderly may be due to access to firearms, diminished cognitive functions, sleep disruptions, poor social interactions, and inattention among primary caregivers. Approximately every 95 minutes an elderly person commits suicide. ... 

Beach and Amir have demonstrated that with a given sample using the same procedures, some markers of depression may define a taxon, while others do not. In other words, both continuous and taxonic forms of depression exist. However, questions remain about the nature of the identified taxon. Is it really a depression taxon or has the exclusive focus on vegetative symptoms changed the nature of the construct Interestingly, certain somatic symptoms, such as sleep and appetite disturbance, are common in many disorders and can be considered the physical component of nonspecific distress (Clark Watson, 1991). Thus, perhaps the identified taxon is not a depression taxon at all and actually reflects general somatic complaints. Only construct validation can address these concerns. 

In contrast to panic disorder, the somewhat more subtle and persistent symptoms of GAD do not always command immediate attention. Although patients with GAD may present with a primary complaint of anxiety, they are more likely to complain of a physical ailment or another psychiatric condition or symptoms, for example, depression or insomnia. As such, many patients with GAD will seek treatment from a primary care physician long before recognizing the need for mental health care despite readily acknowledging that they have been anxious virtually all of their lives. 

Reactive Loss (adverse life events). Physical illness (myocardial infarct, cancer). Drugs (antihypertensives, alcohol, hormones). Other psychiatric disorders (senility). More than 60% of all depressions. Core depressive syndrome depression, anxiety, bodily complaints, tension, guilt. May respond spontaneously or to a variety of ministrations. 

Insomnia is a common complaint in the elderly. As people age they require less sleep, and a variety of physical ailments to which the elderly are subject can cause a change in the sleep pattern (e.g. cerebral atherosclerosis, heart disease, decreased pulmonary function), as can depression. Providing sedative hypnotics are warranted, the judicious use of short half-life benzodiazepines such as temazepam, triazolam, oxazepam and alprazolam for a period not exceeding 1-2 months may be appropriate. Because of their side effects, there would appear to be little merit in using chloral hydrate or related drugs in the treatment of insomnia in the elderly. It should be noted that even benzodiazepines which have a relatively short half-life are likely to cause excessive day-time sedation. The side effects and dependence potential of the anxiolytics and sedative hypnotics have been covered elsewhere in this volume (Chapter 9). 

For the medical practitioner, clients suffering from depression may be especially frustrating to deal with as their complaints—generally somatic in nature— usually result in negative medical examinations that reveal no physical causes for the problem. This multifaceted disorder provides fertile ground for misunderstandings and frustration on the part of both health care providers and the clients. To complicate the matter, about 70% of those who have suffered from depression once can expect a recurrence (Resnick Carson, 1996). 

Individual Behavioral (absenteeism, abuse of drugs or alcohol, hostile behavior, apathy, distracted, etc.) Emotional (anxiety, cynicism, depression, irritability, etc.) Somatic (decline in physical appearance, chronic fatigue, infections, health complaints, etc.) Thinking (lack of concentration, reduced attention, difficulty in remembering, failures in planning, etc.)... 

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