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    Body Aches May Signal Depression

    Counseling May Be Better Than Drugs for Those With Unexplained Physical Ills
    WebMD Health News

    July 20, 2004 -- Why is it that so many people with depression are never identified as having the condition, while about half of those who are diagnosed fail to improve with medications proven to be effective? New research shows the explanations may be in their initial symptoms.

    Depression is a mood disorder diagnosed by tell-tale symptoms such as fatigue, lethargy, or poor sleep. But depression may manifest itself in physical aches and pains that offer no obvious cause, such as unexplained chest pain, muscle ache, trembling, or hot flashes.

    "If you have stomach pain and there's an ulcer, that's an explanation for it. But often, physical ills occur for no apparent reason -- and depression could be a likely cause," says study researcher Robert D. Keeley, MD, of the University of Colorado Health Sciences Center. "Yet unless they are specifically screened for depression, it's hard for some doctors to pick up that it may be depression, especially in the primary care setting."

    After studying 200 patients eventually diagnosed with depression, he reports in the Journal of General Internal Medicine that doctors often failed to make the initial diagnosis, instead misattributing their ill-defined physical symptoms to explanations other than depression. Therefore, no treatment was recommended for those who need it.

    Drugs Not for Everyone

    But even when a depression diagnosis was made, Keeley finds that patients with these physical symptoms were more likely to resist the use of the most-often prescribed therapy -- antidepressant medication -- because they didn't think they were depressed.

    In fact, he reports that those diagnosed with depression based on psychological symptoms were four times more likely to continue taking prescribed antidepressants for six months than those given the drugs based on physical maladies.

    This may explain what experts have long known -- that many depressed patients stop taking their medication, often within weeks of starting it. It also confirms a study last year, published in the American Journal of Managed Care, that the vast majority of depressed patients are unhappy with their treatment.

    In that study, researchers found that nearly eight in 10 depressed patients are given antidepressant prescriptions and almost all had them filled. But within three months, many stopped taking the drugs. Many experts say that at least six to nine months of treatment -- sometimes longer -- is needed to best prevent a depression recurrence.

    "Since the 1990s, evidence suggests that patients with depression do better when the treatment is matched to their preference," Keeley tells WebMD. "For instance, patients who have physical symptoms with no explanation appear to prefer a counseling approach as opposed to getting antidepressants."

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