By Mylika Scatliffe,
AFRO Women’s Health Writer
October is a month dedicated each year to awareness about mental health and depression. Health providers are on a continuous mission to reduce the historical stigma and educate the public at large about mental health and depression. There is no shortage of information and resources about recognizing the emotional signs and markers of depression, but what about the physical symptoms?
Dr. Kamal Bhatia is a general adult and forensic psychiatrist and director of the Mood Disorders Day Hospital at the Baltimore Washington campus of Sheppard Pratt Hospital in Elkridge, Md.
“I’m glad to be talking about this because patients don’t always link together the physical and emotional aspects of depression,” said Bhatia.
Physical ailments ranging from mild to severe are associated with mental illness, depression in particular. Because these ailments can also be associated with so many other conditions, they might not be at the forefront of the mind of someone living with depression.
According to the National Alliance on Mental Illness, research shows that up to 50 percent of people with chronic pain conditions exhibit symptoms of depression, and that depression and anxiety can cause upset stomach, digestive issues, headaches, and body aches, just to name a few.
The physical ailments that accompany the mental aspects of depression can range from mild to severe and from the short term to the long term. Fatigue is one of the most common complaints.
“Patients may suddenly lack motivation and energy with their usual level of activity and feel tired after getting 10 or 12 hours of sleep,” said Bhatia.
According to Bhatia, other frequent physical complaints to go along with depression can include:
- Sleep disturbances – sleeping too much or too little.
- Abrupt changes in appetite – eating too much or too little, leading to rapid changes in weight.
- Vague achiness in the body – headaches, back aches, and other muscle aches that seemingly have no explanation.
- Sexual problems – decreased libido, difficulty becoming aroused, or even performance anxiety.
“Another thing we’ve noticed early on is digestive issues. There is a large concentration of serotonin receptors in our gut. Serotonin is also hypothesized to be an important neurotransmitter playing some role in depression,” said Bhatia.
“We frequently see stomach related or gastrointestinal issues. Increased stress can present as nausea, diarrhea, constipation, any sort of physical complaints to the gut and people often don’t make the connection that it could be anxiety from depression,” Bhatia continued.
The good news is that when these somatic symptoms can be directly linked to depression, they have a good chance of responding to medication, psychotherapy, and lifestyle modifications. Once these physical manifestations are linked to a patient’s depression, it is important to have realistic expectations regarding how long it will take treatment to become effective.
While some symptoms like sleep quality and appetite may improve quickly with medication, patients should realize that recovery is a long road and to allow themselves grace and patience during recovery.
“Most patients have difficulty with the time it takes to get better,” said Bhatia. “It can take a bit of trial and error to find the right antidepressant and dosage and then four to six weeks for them to take effect,” continued Bhatia.
Screening, diagnosing, and treating depression is no longer solely up to psychiatrists and other mental health providers. Primary care physicians more often than not are the providers that are identifying depression in patients and prescribing antidepressants.
“ Primary care physicians are often the gatekeepers. We’re very thankful for our primary care colleagues for addressing this need because we’ve seen some reluctance among the general public to reach out to a therapist or a psychiatrist,” said Bhatia.
If an individual is more comfortable talking to their primary care provider, the most important thing is for their mental health to be addressed.
“The number of available mental health providers is still quite small compared to the need. Primary care providers do a great service for the community by providing some of this help to patients,” Bhatia said.
Fatigue, body aches and sleep disturbances are the more common bodily ailments experienced by those living with depression. The more moderate to severe depressive episodes and their accompanying physical afflictions are less common. Depressive episodes can be so debilitating that a patient can barely get out of bed.
Bhatia described to the AFRO how the body can atrophy in these situations.
“If someone is in such a severe state of depression that they are having prolonged periods of inactivity the body breaks down in sort of a domino effect,” said Bhatia.
“Their muscles begin to waste away, the immune system decreases which leads to a plethora of illnesses and conditions – cardiovascular troubles, high blood pressure, heart disease, dramatic weight changes, thyroid problems, and diabetes for example,” continued Bhatia.
In addition, these conditions can lead to deconditioning of the body, chronic pain and bedsores. Extended periods of no social interaction will eventually lead to cognitive failure. Symptoms severity is also affected by external factors like non-compliance with prescribed medication or treatment plans, substance abuse, or lack of a support system.
There are three levels of care available at the Sheppard Pratt Hospital campuses in Towson and Elkridge, Md. The first level would be the outpatient clinic where a patient can see a therapist or psychiatrist once a week or month for 30 minutes to an hour. The highest level of care would be inpatient where patients require intensive observation because they are not functioning or perhaps even having suicidal thoughts and plans.
Bhatia is the director of the care program between the two, which is referred to as the partial hospitalization program at Sheppard Pratt.
“We call it the mood disorders day program, and patients are seen five days a week, for two to four weeks. The advantage is you meet with a physician or nurse practitioner a couple times a week and you can approach your medication regimen and changes, if needed, more aggressively,” said Bhatia.
“Our goal in the mid-level program is to prevent a patient from declining and having to transition to inpatient care,” continued Bhatia. “Sometimes care is downstream as well. There are patients who are functioning in the inpatient setting and become well enough to transition to the intermediate program.”
The step down to the intermediate level of care is crucial for the patient because they are provided with an additional layer of support before eventually integrating back into the community.
“We continue working with them because the risk of relapse in most patients is fairly high within the first month or so,” said Bhatia.
Bhatia went on to explain that recovery is a long process and patients can plateau.
Self-care is crucial, according to Bhatia, both for patients and for those who love, live with and care for them. Individuals living with depression should take care to eat healthy, maintain good sleep hygiene and social interaction, and receive observations from those that love them. Family members and loved ones of patients should listen, validate what they are going through, encourage them to get help when needed, and to educate themselves about depression and what their loved ones are experiencing.
“If you are living with depression, remember it’s a medical condition for which you should seek help as you would any other illness. It’s not your fault and you didn’t bring this on yourself,” concluded Bhatia.