Many persons who continually complain of pain are actually suffering from undiagnosed depression - Dr. Earl Wright, psychiatrist.
PATIENTS SUFFERING clinical depression often end up at the doctor's office complaining, not about their mental health issue, but about various undefined pain symptoms.
Local studies point to as many as 70 per cent of individuals complaining all the time of physical symptoms, as really fitting the criteria for clinical depression.
"We know that physical symptoms have a high correlation with depression. People who complain of back pain, musculo-skeletal problems and so on, a significant number of those individuals will have depressed symptoms and studies have confirmed this in Jamaica," said Dr. Earl Wright, psychiatrist and director of the Ministry of Health's Mental Health Services. "Depressed people are significantly more likely than others to visit the physician for some other reason than complaining of their depression."
He explained, during a presentation at the recently-held conference of the Medical Association of Jamaica (MAJ), that hormonal systems such as serotonin and epinephrine which are strongly associated with depressive symptoms are also linked to pain.
Depression may also be prevalent among persons suffering other illnesses such as heart disease, stroke, and diabetes. Dr. Wright indicates too that depression can be a risk factor for subsequent physical illnesses and premature events. Most studies (including those conducted on local populations) indicate that more than 20 per cent of individuals attending diabetic and hypertensive clinics have major depressive disorders.
In the local healthy lifestyle survey (2000), respondents were screened for depression using some standardised questions such as: "Have you been feeling down, depressed, hopeless in the past two weeks?" About 52 per cent of females answered "yes" to this question and 42 per cent of males. Another question asked was: "Are you bothered by little interest or pleasure in doing things?" About 36 per cent of females and 29 per cent of males answered positively.
But although depression is so common here, Dr. Wright says that one of the nagging problems, is that a substantial proportion of patients receive no treatment or inadequate treatment in the primary care setting.
"One of the reasons that we associate with the underdiagnosis and under- treatment of depression is the whole role of stigma and, both physicians and patients, many times, seek another or less stigmatised explanation for the patient's illness. Some patients are treated for various other complaints while the mood disorder goes undiagnosed and untreated," he said.
Dr. Wright stressed that the medical community has a responsibility to improve its diagnosis and treatment of this very common illness. Complications of major depression include suicide, which has been increasing here over the last few years and a 1999 study, suggests that more than one-half of the persons committing suicide in Jamaica were suffering from a major depressive disorder, often undiagnosed and untreated.
Signs and symptoms of depression
- depressed mood
- loss of interest in life
- lack of concentration and indecision
- thoughts of death and suicide
- back ache
- headaches, dizziness
- unsteady feeling, faintness
- shortness of breath
- lump in throat
- butterflies in stomach
- feeling dread
- problems sleeping
- heart beating fast
- startle response
