Depression: Beyond
the Mind

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By Thiyashi Koththigoda

Depression is one of the most common mental illnesses globally, so most people are likely aware of it. It’ll seem as if depression is a purely emotional disorder to many. Yet the truth is that it’s a condition that affects both body and mind, giving way to many physical symptoms. But first, let’s try to understand what depression is and what may cause it.

What is depression?

There’s much misunderstanding surrounding depression, especially in a conservative country like Sri Lanka. Although it’s seen as just ‘being sad’, major depressive disorder or clinical depression is a medically recognised mood disorder that can severely impair the quality of one’s life. It’s characterised by prolonged feelings of sadness, disinterest in day-to-day and fun activities and overall declined functionality at work and home. These are some prevalent symptoms, and if they persist for more than two weeks, they could indicate a depressive episode. The causes of depression are not very clear-cut, although research has found some links. It’s believed that those with depression have different brain chemistry, resulting in a chemical imbalance that affects mood. Genetics can play a factor too. Depression can run in families, with a 70% chance of depressive traits being present in those whose family members suffer from the condition. Certain personality types can also be more prone to developing depression. Those inclined to be pessimistic, overwhelmed by stress, or possessing low self-esteem are higher at risk.

Alongside the many psychological symptoms, depression can manifest in many physiological ways. Although symptoms can be unique to every individual, here are some that are commonly seen in many sufferers.

Body pain

Patients with depression often report having different types of body pain that affect areas from their joints to their limbs. Some may experience all-over chronic body pain. A 2017 study showed that those with depression were 60% more likely to experience back pain. Although the cause is debated, researchers chalk it up to the impaired regulation of neurotransmitters in the brain, such as serotonin which plays a part in mood regulation. Other studies have shown that sufferers of depression have a reduced ability to tolerate pain, making them more sensitive to physical pain. Some may even experience dull throbbing pain around the eyes, known as ‘tension headaches’. This pain occurs when tension is held in the neck and scalp due to feelings of stress. Sufferers may even experience chest pains that result in heart palpitations and difficulty breathing. These are panic attacks caused by anxiety which often accompanies depression.

Digestive issues

Scientists refer to the stomach as the ‘second brain’ as the brain and gut have been observed to have a two-way connection with each other. Often, emotions can trigger reactions in the stomach and intestines. Researchers have linked cramps, bloating and nausea to poor mental health. In fact, Harvard Medical School found that an inflamed digestive system can both be caused by or result in depression. Much like bodily pains, this is also associated with the neurotransmitter serotonin. Serotonin aids in the digestive process, with 90% of the body’s serotonin being produced in the digestive tract. There is even research being done into the microbes in the gut, with links being explored that they contribute to mood regulation and immunity.

Fatigue

A hallmark symptom of depression is a feeling of tiredness and experiencing a constant lack of energy. This physiological (and mental) state results in sufferers being unable to carry out their day-to-day activities. What accompanies the fatigue is also difficulty concentrating and a sense of apathy. Fatigue in those with depression is linked to several reasons. The first is that neurotransmitters like dopamine and serotonin are erratic, causing a dip in energy levels. One other common cause is disordered sleeping. This is where the sufferer may not sleep enough, sleep too much or doesn’t manage to get restful sleep. This lack of proper ‘restorative sleep’ is detrimental to overall health and can result in low energy and sluggishness during the day.

Poor psycho-motor function

When the body and brain work together to complete a task, it’s called psycho-motor function. Depressed people may feel as if they’re thinking and moving at a different pace than how they would normally. There are two ends to this spectrum. Some may process thoughts slower and have sluggish movement, while others may have anxious and intrusive thoughts coupled with restlessness and fidgetiness. Some common signs of decreased psychomotor function can be spotted in a person’s speech, eye movement, facial movements and actions of their body. Lower volume, frequent pauses, poorer articulation and monotonous communication can be picked up from their speech. With eye movements, a fixed or distracted stare and a decline in eye contact are things to be on the lookout for. Facial expressions will often be unresponsive and flat as well. Finally, more lethargic body movement and difficulty performing fine motor tasks like writing are also good indicators.

Appetite changes

This is a definitive physical symptom that can help medical personnel diagnose depression. Any rapid weight gain or loss over a short time indicates a physiological disruption to a person’s wellbeing. On the one hand, ‘emotional eating’ is a method of self-medication to cope with negative feelings. The stress hormone cortisol can be affected during depression, resulting in eating more. On the other hand, loss of appetite can also occur. Some may experience digestive issues, as mentioned before, and lose the desire to eat. This is why eating disorders like anorexia nervosa or binge eating disorders often go hand-in-hand with depressive symptoms.

A positive outlook

Learning to identify both the physical and mental symptoms of depression is the most crucial step towards getting the help you or your loved one may need. Although a debilitating condition, it’s one of the most treatable mental illnesses. With vast and effective treatments ranging from medication to therapy to lifestyle, 80% to 90% of patients eventually respond well. Observation, understanding and empathy are the key to a better quality of life despite mental health struggles.