Depression: Physical Pain and Diagnosis

Diagnoses of depression keep climbing. Healthline puts the figure at roughly 1 in 10 people who will deal with some version of it during their lifetime. What sets it off varies widely: a relationship ending, a frightening medical report, money running short, a layoff, and plenty of reasons that never fit neatly into a list. And the condition does not float somewhere above the neck, separate from the rest of you. Bodily symptoms tend to show up right alongside the mood.

Healthline describes the relationship as a loop that runs both directions. Depression can produce pain, and ongoing pain can pull a person into depression. That connection is part of why certain medications get prescribed the way they do. Drugs like Cymbalta and Effexor, along with older tricyclics such as Elavil or Norpramin, have been used specifically for the chronic pain that travels with depression. Cognitive behavioral therapy is another route, aimed less at erasing the pain and more at building ways to live with it.

WebMD lays out the physical side in some detail. Headaches and migraines are common, and anyone with a history of them may notice they get worse during low stretches. Back pain shows up too, upper and lower, often reaching into the shoulders, with stress feeding the ache. Muscle soreness and joint pain can sharpen, and arthritis in particular tends to feel worse. Chest and lung pain can intensify, and panic attacks become more frequent, though chest pain should never be waved off, since it can signal something that needs emergency care right away.

The gut gets involved as well. Nausea, queasiness, diarrhea, constipation, cramping: any of these can tick upward. Fatigue is another hallmark, the kind where no amount of sleep leaves you rested and simply getting out of bed in the morning feels beyond reach. Sleep itself goes sideways, whether that means trouble falling asleep, waking through the night, or sleeping far too much. Appetite and weight swing in either direction, sometimes dramatically. Some people report dizziness or the sense they might faint.

The DSM-5 does not yet carry physical pain on its official symptom checklist for depression. Even so, the overlap between pain and depression has been drawing steady attention from researchers in psychology and psychiatry, and recognition of it keeps growing.

What follows are reflections from Kim B.

A decade ago I hurt my back badly enough to need surgery. Recovery ran six months, with physical therapy layered on top, and the results were middling. The operation itself took the acute pain away. The rest afterward let the incision heal. The therapy rebuilt some of the strength and stamina the injury and the procedures had drained out of me. But when all of it was finished, I was not the person I had been physically. No doctor, nurse, or therapist could reassemble Humpty Dumpty into his old shape.

They rated me 30 percent disabled. Tasks I had done without a second thought were suddenly off the table. Bending to grab something I had dropped became a problem. For a while I could not even bend to tie my own shoes. The small stuff of ordinary life turned into the large stuff, and a lot of daily routine now needed someone else's hands. The moment it truly landed was when I realized I could not lift my own toddler safely, afraid of hurting her or myself in the process.

Then my employer let me go, since I could no longer meet the physical demands of the work. That is when the depression arrived in earnest. The life I had assumed would always be there, the one I had barely stopped to appreciate, was gone for good. I stopped sleeping. My weight went up and down. I sank into a long stretch of feeling sorry for myself and feeling like less of a man. For a lot of men, I think, identity rides heavily on what they do for a living.

Here is what I keep running into: with the physical limits in place, the smallest errands can flatten me, even while my mind works perfectly well. On any given morning it would be just as easy to pull the covers back over my head as to throw them off. I decide, every day, not to hand my depression over to the pain. I make myself get up and make the bed so the bed stops inviting me back. I shower and put on real clothes instead of letting things slide. Turning into a shut-in, scared to leave the house, would not take much effort at all.

When I push to be a little more than I assume I can be, the pain quiets down to something I can tolerate. The effort registers less than I expect, and oddly it leaves me feeling more awake than I did before the injury. I would rather live the thing than watch it from the sidelines. I hope you pick the same.

Sources: WebMD, Depression: Recognizing the Physical Symptoms; DSM-V, American Psychiatric Association; National Institutes of Mental Health; Healthline.