The role of physical symptoms in depression and in achieving remission

The proportion of depressed patients treated according to guidelines is very low, ranging from 12 to 25% depending on the studies. One of the reasons is a low recognition rate in great part due to a somatic presentation of depressed to their doctor. Indeed the number of somatic symptoms present in depressed, when systematically asked by an interviewer is even higher (4.8) than in patients consulting for physical reasons (2.8). This figure could be explained by the high comorbidity (about one third) observed between physical diseases and depression, however when assessing depressed without physical diagnosis the number of somatic symptoms remains 4.6.

It has been suggested that patient may denie the existence of a psychological condition or may express their symptoms physically as a consequence of a difficulty to express psychologically.

Actually only 10% spontaneously consult for psychological reasons while 1/3 do because of painful symptoms and 40% because of other physical symptoms.

Contrarily to the expectations of the different theories the % with a denial of the psychological nature of their disorder is low (about 10%). Even more interesting: the tendency of patients to complain physically is not correlated with a low psychological expression but on the contrary both psychological and physical complaints are low or high depending on cultural and personal characteristics.

Therefore, it becomes very clear that the unexplained physical symptoms are just part of depression. This is of great importance since it has to be taken into account for diagnosis and treatment. In addition numerous data show that for a long term remission the absence of residual symptoms is necessary, even if these symptoms are mild. Since these symptoms are typically of a depressive nature, it is necessary to take into account the full range of the symptomatology, including physical symptoms, in order to achieve the best possible treatment.