Anyone who thinks depression is all in one's head has never been depressed - or never realized it. Depression affects more than the mind - it has significant physical symptoms as well. Some of these were discussed in Part 1 of this series, Decreased Energy or Activity in Bipolar Depression. In this article we discuss the second group of symptoms listed in Red Flags to Depression.
Bipolar Depression: Physical Symptoms
- Unexplained Aches and Pains
One theory about why depression causes body aches is that depressed people are often:
- Physically stressed due to sleep deprivation (from insomnia); or
- Just as physically stressed, even though they are sleeping as much as or more than normal, because the sleep is not restful.
Unrestful sleep is a significant component of both chronic fatigue syndrome (also called myalgic encephalopathy) and fibromyalgia, two conditions characterized by moderate to severe body aches. It isn't surprising, therefore, that there is a close association between fibromyalgia and depression/anxiety.
In addition, depressed people often have higher than normal levels of the hormone cortisol, often known as the "stress hormone." Too much cortisol is often seen in patients with chronic pain, though a cause-and-effect relationship has not been established.
- Weight Loss or Gain
- Decreased or Increased Appetite
Loss of appetite is common with depression - but it's also common for depressed people to turn to food for solace. Thus, both weight loss and weight gain can be symptoms of a depressive episode.
One reason why people turn to food - and particularly fattening foods - when depressed is that carbohydrates raise the brain's level of serotonin, one of the neurotransmitters that are associated with depression when levels are too low. Also, an excess of cortisol is thought to cause the body to store fat inappropriately.
- Psychomotor Agitation or Retardation
Psychomotor agitation is an increase in activity caused by mental rather than physical tension. Typical behaviors seen with this symptom include pacing, wringing hands, finger- or foot-tapping, and other similar restless actions.
Psychomotor retardation refers to a slowing of both thought and physical activities. Regular tasks such as brushing teeth or eating may be performed in an unusually slow and/or deliberate manner.
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O'Brien, EM, et al. Negative mood mediates the effect of poor sleep on pain among chronic pain patients. Clinical Journal of Pain. 2010 May;26(4):310-9.
Harvard Mental Health Newsletter. Depression and Pain. Harvard Health Publications. 2004 Sept.
Van Uum, SH, et al. Elevated content of cortisol in hair of patients with severe chronic pain: a novel biomarker for stress. Stress. 2008;11(6):483-8.