How Depression Manifests in the Body
Depression is both a mental and a physical disorder.
When talking about depression, it is important to recognize that the mind and the body cannot be separated. When the mind becomes ill, so does the body. The human body is beautifully complex. The mind informs the body and the body informs the mind. The two work in harmony... until they don’t.
The onset of depression brings with it a disregulation in the communication between mind and body.
Mentally and emotionally you may experience:
Depressed mood – feelings of emptiness, hopelessness, or sadness
Diminished interest or pleasure in activities you used to enjoy
Persistent feelings of guilt or shame
Feelings of worthlessness
Difficulty making decisions
Trouble concentrating or lapses in memory
Thoughts of death or suicide
Physically you may experience:
Chronic fatigue or loss of energy
Appetite changes (both loss of appetite and overeating or binging)
Insomnia or hypersomnia
Decreased pain tolerance
Headaches
Disruption in gut function (constipation, diarrhea, stomach pain, bloating)
Chronic musculoskeletal pain (pain in the absence of disease or injury or pain that persists after an injury has healed)
Did the last few physical experiences surprise you? They surprised me too. While I’ve long known that depression is often accompanied by physical symptoms, I was surprised to learn just how widespread the effects are. My interest in the brain-body connection led me to study three conditions:
Fibromyalgia
Irritable Bowel Syndrome (and other functional bowel disorders)
Chronic Pain
What do all these conditions have in common? They are all highly correlated with depression. Each has been found to be exacerbated by depression, and though research is still relatively sparse in this area, there is evidence that depression, anxiety, or trauma may even initiate these conditions in some cases. Why are pain and depression so intertwined? To understand the connection, we need to look at the way our bodies handle physiological stress.
Stress in the body
Our bodies are equipped with a stress response system to help us to respond appropriately and adaptively to the threat in our environments. This system, known as the hypothalamic-pituitary-adrenal (HPA) axis, plays a vital role in survival and creates a healthy response to stress. The axis becomes activated when the brain perceives a threat and sends signals to the body to prepare to react to the threat. However, in those with anxiety and depression, the HPA axis does not function optimally. This system, meant to help us manage stress in a healthy way, becomes desensitized and deregulated. The HPA axis becomes activated frequently by perceived threats (these are the negative thoughts, anxieties, and fears that accompany depression). The chronic activation of the HPA axis leads to widespread inflammation in the body. Inflammation then leads to a whole host of dysfunctions in the body. And it’s not a one-way street. The communication between brain and body also goes the other way. Just as depression that begins in the mind can exert its effects on the body, inflammation in the body can also exert its effects on the mind, leading to depression.
When emotions emerge physically
Emotions need to be heard. Though emotions often do not accurately portray reality, they are nevertheless important. Emotions act as signposts, directing us inward; inviting us to acknowledge and correct something that is out of balance. For example, you may feel worthless or that you’re to blame for all the negative events in your life. This emotion does not reflect the truth of who you are nor does it reflect reality. It does, however, invite you to evaluate where the emotion is coming from. When we are in the habit of ignoring or suppressing emotions as they emerge, our immensely wise bodies will use other tactics to alert us to something that’s out of balance. Physical symptoms may emerge. The body communicates to us in many ways and when the communication system of emotions is not attended to, physical pains can be our bodies’ back-up plan. The suppression of emotions causes our bodies to be in a constant state of stress (the HPA axis gets triggered). The physiological stress response then sets off the pathways that can lead to both depression and pain.
Emotions are our motivators. They are agents of change. Though they can feel overwhelming, they are not there to do harm, but rather to bring about healing. Many of us were taught to bottle up our emotions. We are not often told that emotions have value. Allowing ourselves to feel our emotions and be curious about what they mean is a skill many of us need to learn as adults. When emotions are left unaddressed, the hurt that the emotion was pointing to persists. It will continue to exist behind the scenes, directing our behaviors without our knowledge and even leading to chronic physical pain. Because of this, attending to and working through emotions we have a hard time facing can be healing to both the mind and the body.
What to do next
If you are concerned about any physical symptoms you are experiencing, it’s a good idea to see your primary care physician. This article is not meant to serve as medical advice, but to bring awareness to the varied ways that depression can look in the mind and body. No two people have the same experience with depression.
Physical illness that is fueled by depression or anxiety often does not respond well to medicinal treatment alone. Cognitive behavioral therapy (CBT) has been shown to be highly effective for treating depression with physical symptoms. If you are struggling to cope with a gastrointestinal or pain disorder that is not well-controlled, consider adding therapy to your treatment plan.
Note: If you’re interested in the relationship between functional bowel disorders and depression, stay tuned. I plan to discuss the microbiome-gut-brain axis in a future blog post.
Steps you can take today
Awareness is our greatest agent of change.
The next time you feel a strong emotion, take a moment to notice your habitual response.
Do you immediately choose to think of something else?
Do you seek a distraction (food, social media, Netflix)?
Note: you may notice the distraction behavior before you notice the emotion. If you pay attention, the distraction behavior can alert you to the emotion that is being avoided.
See if you can name the emotion.
Are you bored? Angry? Ashamed? Embarrassed? Frustrated?
Identify what the emotion is pointing to.
This takes some work and if you are new to working through emotions, it can be helpful to work with a therapist who can guide you through it.
Identifying the ways in which emotions and mood disorders (such as depression) are connected to our physical well-being is the first step to healing both the mind and the body. Tune in to your mind and body today without judgment for what you discover. Remember that healing takes time but it’s worth it.
Click here to learn more about chronic pain counseling.
