Physical symptoms with depression may persist

Patients with depression often have physical symptoms such as pain or stomach problems, and these are less likely to clear up with antidepressant treatment than is the depression itself, new study findings suggest.

There has been little research on outcomes of physical symptoms in patients treated for clinical depression, Dr. Kurt Kroenke and his colleagues note in the Journal of General Internal Medicine.

Results of a study looking at antidepressant treatments show that "physical symptoms tend to improve, but not to the same degree on average as emotional symptoms," Kroenke told AMN Health.

Researchers with the study, based at the Indiana University School of Medicine in Indianapolis, followed 573 depressed patients treated by 87 physicians over nine months of therapy with Prozac, Paxil (known as Seroxat in some countries), or Zoloft.

At the outset, more than one third of the subjects reported fatigue and sleep difficulties, back pain, gastrointestinal problems, difficulty breathing, dizziness and palpitations.

Depression improved rapidly over the first four weeks, followed by continued gradual improvement over the next eight months.

Physical symptoms also declined substantially during the first four weeks, and then seemed to plateau. "There remained a substantial reservoir of unresolved symptoms," particularly pain symptoms, the investigators write.

These physical symptoms have a considerable impact on quality of life, Kroenke noted. So by "simply starting an antidepressant and asking patients if they are less depressed, doctors will be missing part of the picture."

He suggests that "if one class of drug works for some symptoms but not all, one should consider a higher dose or switching to a different medication." For example, there is evidence that newer antidepressants that work on both serotonin and norepinephrine are more effective against pain.

There are also non-medication approaches for treating persistent pain, Kroenke said, including pain self-management programs, cognitive behavioral therapy and physical therapy.

SOURCE: Journal of General Internal Medicine, August 2004.