Depression symptoms are often described as a mood that is despairing and suicidal. The truth is that depression is more complicated than that, manifesting itself in a variety of symptoms. Depression is also closely tied to chronic illnesses, including chronic pain, that make depression symptoms hard to spot or identify as depression. Especially for those with chronic pain (and their caregivers), it is important to recognize depression symptoms, including how they feel physically, mentally, and emotionally.

Physical depression symptoms

Even in the absence of a previous chronic pain diagnosis, depression can cause physical pain. Many people with depression report physical symptoms such as:

  • Tightness in the chest
  • Neck and back pain
  • Headaches
  • General achiness overall
  • Cramps in muscles
  • Stomach pain

Some of these symptoms may be a result of tense muscles and stress, but new research is finding that pain and depression may share a neurochemical pathway that triggers pain. Dr. Salim Hayek, a cardiologist at Emory University School of Medicine in Atlanta, studied the connection between chest pain and depression, specifically in people without coronary artery disease. The connection between depression and more frequent chest pain for those with coronary artery disease had already been established, but Dr. Hayek wanted to see if patients with depression and no cardiovascular issues experienced similar frequency of chest pain.

The results were startling: men or women with depression were three times more likely to experience frequent chest pain, with or without underlying cardiovascular illness.

Dr. Hayek made the connection between pain and depression, noting:

“We found that depression is strongly associated with the frequency of chest pain in adults with and without underlying coronary artery disease, and that patients with depression and heart disease did not have an improvement in their chest pain frequency even after coronary intervention. One possible explanation for our findings is that pain and depression share a common neurochemical pathway.”

Patients in the study whose coronary artery disease was resolved but who remained depressed still had frequent chest pains. Reduction in chest pain was only experienced by those patients who received treatment for their depression.

Depression does hurt, and pain may be one of the first symptoms to appear.

Mental and emotional depression symptoms

Mental and emotional depression symptoms can include any or all of the following:

  • Sadness or feelings of emptiness
  • Feeling remote or isolated from other people
  • Extreme fatigue
  • Sleeping excessively, or inability to sleep
  • Excessive eating or not eating
  • Loss of interest in regular activities, including sports, hobbies, passion projects, and intimacy
  • Restlessness and an inability to settle down or relax
  • Slow cognition – fogginess in the brain, forgetfulness, or slowed thinking
  • Frequent thoughts of self-harm, death, or suicide
  • Anxiety
  • Fixation on past failures
  • Feelings of guilt or worthlessness
  • Short-temper and lack of patience

For men in particular, excessive anger and impatience seems to be a prime depression symptom.

In young children and teens, depression symptoms may include any of the above plus:

  • Excessive worry
  • Not wanting to go to school
  • Clinginess (younger children)
  • Difficulty with body image (teens)
  • Dramatic changes in grades and school participation
  • Being underweight (young children)
  • Alcohol or drug use (teens)
  • Avoiding interaction with peers (teens)
  • Self-harming activities, like cutting (teens)

Older adults often present with depression symptoms such as memory loss, agitation, and increase in physical aches and pains.

In some people, depression appears to actually alter their perception of time. A meta-analysis of 16 studies of depression found that patients with depression subjectively experience time differently than those people without depression. This could result in patients who feel hopeless because it seems that they will always feel depressed.

These symptoms are generally severe and prolonged enough as to interfere with daily functioning, such as family life and work.

It is important to note that many people feel some of these symptoms at some point in their life. This does not mean that they are depressed. The above mental and emotional depression symptoms can arise when a life event occurs (e.g., losing a promotion or a difficult time with a partner) or when there is a death in the family. Grief and episodic sadness are not the same thing as depression. Whereas these two things (grief and episodic sadness) have a specific triggering event, depression can be caused by a number of different things, including neurochemical makeup.

Signs of depression

Depression can be very difficult to diagnose and treat, but there are a few signs that should be taken as very serious and prompt immediate action.

1. The depressed person begins to talk openly about suicide, including methods and timing

Thoughts of suicide are not uncommon, even in healthy people, but thinking about it and planning it are two separate actions altogether. Depressed people who begin to get specific about suicide or conduct research on methods require immediate, emergency treatment.

2. The depressed person suddenly perks up

This may seem like a good sign, but in some depressed people, this could mean that they have decided on a time and date for a suicide attempt. Having this deadline may produce feelings of happiness. This is also a cause for immediate, emergency treatment.

3. The depressed person begins to “settle their affairs”

Many depressed people who decide on suicide will begin to give away possessions or re-home their animals. They may open savings accounts for dependents or draft wills. While drafting a will and saving money are good things to do in general, for depressed people, this can be a warning sign that a decision has been made.

If you or a loved one are experiencing any depression symptoms or are having suicidal thoughts, get immediate help by calling the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255). Veterans can use that same number and press “1” to reach specifically trained volunteers. If you need it, reach out and get help. You are not alone.


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