Signs of depression
By Eveline Gan, TODAY | Posted: 06 January 2009 1036 hrs

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SINGAPORE - When Mr Tan - a teacher who declined to give his full name - began complaining about frequent neck and back aches, nausea and heart palpitations three years ago, his wife thought they were just a figment of his imagination.

After all, regular health checks with the family doctor had given him a clean bill of health.

Said his wife, Mrs W L Tan: “He kept complaining about aches and ‘knots’ in his stomach. He would also gag and vomit several times before he headed off to work. But he would be back to normal by evening. So, I thought they were all in his head.”

But the symptoms weren’t a figment of his imagination and Mr Tan is not as “fit” as he looks. He suffers from depression.

More than just a disorder of the mind, psychiatrists TODAY spoke to said depression can also cause physical symptoms such as those Mr Tan experiences.

Depression afflicts about 5.6 per cent of Singaporeans, according to a 2004 National Mental Health Survey.

In fact, Dr Lim Boon Leng, a registrar at the Institute of Mental Health’s (IMH) general psychiatry department, estimated that up to three-quarters of those with depression may complain of bodily discomfort.

“Physical symptoms are part and parcel of depression. Biologically, there is a link between one’s mood and pain because they share similar neurotransmitters,” said Dr Lim. Neurotransmitters are chemical messengers which travel between nerves. This also explains why those who are already suffering from chronic pain may develop depression.

In addition to psychological signs, it is not uncommon for patients to experience symptoms such as frequent dizziness and tiredness, discomfort in the chest and shortness of breath.

Persistent and frequent aches and pains - including neck and back aches as well as abdominal pains - are often part of depression, too, said Dr Adrian Wang, a consultant psychiatrist at Gleneagles Medical Centre.

Depression may also increase the risk of other medical conditions such as osteo­porosis and heart attacks, according to the psychiatrists.

“Chemical and hormonal changes in the body caused by extreme mental stress has a negative effect on the body. A person who is highly stressed may experience higher blood pressure or irregular heart rhythm,” said Dr Lim.

Another reason, explained Dr Wang, could simply be due to negative lifestyle habits of the patient.

“People who are depressed don’t take good care of themselves. They’re less likely to adhere to good lifestyle habits so some preexisting medical problems such as heart disease and diabetes can worsen,” he said.

Most of these bodily symptoms usually go away when the condition is treated and managed. For Mr Tan, whose condition has since improved, treatment and family support have helped him. He is still undergoing treatment.

But the trouble is, said Dr Wang, sufferers are often unaware of their problem.

“About half of them probably won’t know they have depression. This is where their doctors’ reassurance comes in,” said Dr Wang.

“Because physical symptoms contribute significantly to a patient’s misery, the worst thing the doctor can do is to say it’s all in your head. Family members and care­givers should not dismiss the symptoms as normal wear and tear of ageing.” - TODAY/ar