Physical symptoms are just as common as psychological ones and often form the presenting complaint when depressed patients consult in general practice. Core symptoms of depression include pain and tiredness. These have been recognized since the early days of psychiatry. (Indeed, a more insightful way of looking at the problem would be to retreat from the somewhat arbitrary mind/ body split in which, at any rate in Western societies, we view the experience of distress.)
Pain and fatigue and depressed mood can in fact be thought of as an army - or at any rate a platoon - that marches together; often, the depressed mood is the most prominent feature and the correct clinical diagnosis of a depressive illness is easily made.
Sometimes, however, if patients feel reticent about their emotional distress, the pain or the tiredness may be presented as the main problem. Depression of mood is the underlying problem in many patients given otherwise mystifying labels of 'chronic fatigue syndrome' or 'chronic pain syndrome'.
There may be effects on physical activity, with unwanted excessive movement - agitation (agitated depression) - or marked reduction of activity - the so-called retardation (retarded depression) - where the patient may take to bed or chair and become physically slow. This may progress to depressive stupor, although this is now very rare. Older patients may show marked intellectual impairment (depressive pseudodementia). Other physical symptoms include constipation or diarrhoea, disturbances of the menstrual cycle including cessation of the menstrual periods (amenorrhoea), loss of energy, and loss of interest in sex (loss of libido).
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