Aches and pains linked to depression, anxiety

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Aches and pains linked to depression, anxiety

Izelle Theunissen

You're tired, your head aches and your tummy just doesn't feel right, but the doctor can't give you a diagnosis. What's wrong? IZELLE THEUNISSEN reports.

Headaches, tiredness, abdominal complaints and muscle aches are some of the most common physical symptoms health care workers in primary health care encounter. But often, the physical examination of the patient and medical tests turn out to be perfectly 'normal' and the doctor or health professional can't find a medical explanation for the complaints.

Dr Jacqueline Muller of the Mental Health Information Centre of South Africa (MHIC) calls these unexplained aches and pains somatoform symptoms. She says they may be transient at first, but can become more enduring and have an unpleasant impact on a person's day-to-day life.

To mental health experts it has become clear that these somatoform symptoms are important symptoms of depression and anxiety. 'For many years psychological symptoms have been the mainstay in the diagnosis of depression and anxiety. For instance, a depressed mood, lack of pleasure in life, guilt feelings, low energy, thoughts of death and sleep or appetite changes were seen as the most important symptoms when diagnosing depression,' Dr Muller says.

'Yet research has shown that almost three out of every four people with depression will present to their primary care professional with only physical symptoms. This emphasizes that primary health care professionals should be aware of the overlap between mental and physical health, else a treatable condition may result in many unnecessary tests or referrals to specialists - with no symptom relief for the patient.'

The reason for this is interesting: some of the same neuro-chemicals and hormones that play a role in stress are also implicated in depression and anxiety. For example, when a person perceives danger, this message is relayed to the brain, and the body changes so that it can adapt to survive the threat.

Various brain areas, neuro-chemicals (e.g. noradrenaline and serotonin) and hormones (e.g. the 'stress hormone' cortisol) are involved in relaying the message via the spinal cord so that the body can prepare to react. The heart starts beating faster, breathing is more rapid, blood flows to the muscles, wound healing is increased, the pain threshold may decrease and basic needs such as eating or sleeping become less important.

'With prolonged stress, however, these changes become damaging to the body, and symptoms such as tiredness, headaches, muscular and back pain, insomnia, indigestion as well as poor attention and concentration may emerge.

Chronic stress may also be linked with cardiovascular disease (e.g. hypertension), diabetes, cancer and various other medical illnesses,' Dr Muller says.

'Although we still have to learn a lot about the complex effects of mental health on physical well-being, and the psychological effects of chronic illness, the inseparable relationship between the body and mind is undeniable.'

Mind vs. body?

Why do we think about our mental and physical health as being two separate things?

The 17th century philosopher René Descartes conceptualised the distinction between the mind and the body, viewing the mind as being completely separate from the body.

But, for almost two centuries, mental health advocates have been trying to put them back together.

'This separation between so-called "mental" and "physical" health has no real relevance to the scientific understanding of health in the 21st century, yet the myths and misinformation persist," says Dr Patt Franciosi, president of the World Federation of Mental Health.

'The time has come to reinforce what we stand for: mind and body are inseparable. Health is a complete state of well-being; there is no health without mental health.'

Ms Charmaine Hugo, director of the Mental Health Information Centre, says it's time for mental health care to be mainstreamed, and for the stigma and discrimination attached to people with mental illness to end.

'There is no excuse for reducing funding for the delivery of mental health services.

'It is vital that the prevention of mental illness and the promotion of mental health receive their fair share of public health resources,' she says.

More information:

Article courtesy MRC News: www.mrc.ac.za

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