This article came from Psychology Today. In the five years of my depression (I’m now on the other side of the black box of depression), I found many physical manifestations of what I thought was an emotional disorder. I still find that when the black cloud of depression creeps too close to me, I notice pains in my chest and lower back. That’s a signal for me to use the tools in my toolchest to return to stability…and the pains go away.
Depression is a disorder of the body as much as of the mind. Consider
that several of the core symptoms of the condition manifest in body systems: depression invariably expresses itself in a change of appetite, usually inhibiting the desire to eat, but occasionally reversing course, as in atypical depression, and increasing it.
Similarly, the body’s need for restorative sleep is profoundly disturbed, and nearly all depressed individuals experience sleep problems; 80% complain of insomnia, another 15% sleep excessively. Insomnia by itself appears to be a risk factor for depression. Most patients complain of body fatigue. In many, energy loss is so overwhelming that physical movement is arduous and grinds to a paralyzing halt.
But of all the signs that depression has a neck-down presence, none is more insistent than physical pain. For a substantial number of people, possibly up to half of depression sufferers, bodily pain is the way depression presents itself.
The pain is often vague and unexplained by injury. It may show up as headache, abdominal pain, or musculoskeletal pains in the lower back, joints and neck—alone or in any combination. The painful physical symptoms of depression typically take the form of multiple somatic complaints.
The trouble is, too often neither sufferer nor doctor is aware of the true source of the problem and the depression goes untreated as well as unrecognized. It’s not that the pain is “all in the head.” No, the pain is indeed real, but it likely drives many people to primary care physicians or orthopedists in the mistaken belief that something has gone awry in their body. And there follows an unproductive search for an organic source.
In a study of over 25,000 patients at 15 primary care centers on five continents, Seattle researchers found that 50% of all depressed patients worldwide report multiple unexplained physical symptoms. It’s wasn’t that such patients were any less willing or able to express emotional distress. They readily acknowledged depressed mood when specifically asked about it.
Like the emotional symptoms, the painful physical symptoms of depression arise in specific nerve pathways presided over by the neurotransmitters serotonin and norepinephrine. From their base in the brainstem, such pathways travel up into the highest reaches of the brain, the frontal cortex, where they help regulate thinking and mood. They also travel up to the brain’s hypothalamus, where they regulate eating, sleeping, and sex drive.
But serotonin and norepinephrine pathways also travel down into the spinal cord serving the rest of the body. And therein lies the problem.
As the body goes about its tasks, there are constant sensations associated with the routine functioning of the body, such as digestion in the stomach and abdomen. The central nervous system is also fed routine inputs from the musculoskeletal system throughout the body. But normally those sensations are suppressed from consciousness and ignored. That’s what allows you to pay attention to the world outside your body.
And that suppression is normally accomplished by serotonin- and norepineprhine-dependent nerve fibers descending from the brain into the spinal cord. But they become dysfunctional in depression and fail to operate efficiently. As a result, routine sensory input “escapes” up into the brain, where it is interpreted as uncomfortable or even painful physical symptoms when in fact nothing is wrong.
Remember that the pathways of healing for one depressed is a three legged stool – body, soul, and spirit. I hadn’t had an article strictly on the body for quite a number of blogs and thought it was about time.