Depression is still underestimated, despite its high incidence, and its impact on sub- jective quality of life. To accurately diagnose and to adequately treat depression are still the key points to obtain a good response during acute phases and to reduce the risk of relapses/recurrences. Somatic symptoms (namely, headache, stomachache, on the back pain, etc.) may be precursors or prodromals of a depressive episode, preceding for years the onset of mood disorders. Nonetheless, their detection is complicated, because somatic symp- toms are often underestimated or misinterpreted. Physical symptoms are part of typical depressive symptomatology. Changes in en- ergy, sleep, neurovegetative functions and sexual activity are common during a ma- jor depressive episode. Nonetheless, special populations of patients may show only this aspect of depression. Cognitive symptoms of depression in the elderly or during childhood or adolescence are often “covered” by the presence of physical symp- toms; depressed mood or low energy levels are considered by the patient (and some- times by physicians) as the “obvious consequence” of enduring physical symptoms, that are disturbing, interfering with social adaptation and thereof producing signif- icant levels of impairment. The accurate detection of all the aspects of a mood disorder is the first step, espe- cially in special populations of patients (elderly, childhood, pregnant women, etc.). Early detection of mood liability, mood instability, low energy levels, diurnal vari- ations, loss of interest and pleasure is fundamental for a correct diagnosis. Some- times, patients are closely focused on physical symptoms and tend to explain every other psychological manifestation as a consequence of the loss of subjective well- being. The aim of our observation is to reconsider the importance of a complete psy- chopathological assessment of patients with physical/somatic complaints. This is im- portant for two main reasons: 1) to consider physical complaints as a part of a more complicated syndrome; 2) to achieve as a treatment goal, a remission and not only a reduction of frequency or intensity of these symptoms. Findings from the literature show that physical symptoms may precede and follow ma- jor mood episodes, and may contribute, as residual manifestations, to increasing the risk or relapse or recurrence. Our aim is to consider as a new treatment option, these drugs that seem to be as equally effective on mood as on physical symptoms (SNRI). A new SNRI (duloxetine) seems to be useful in order to improve mood symptomatol- ogy during acute major depression episodes and to reduce distress due to the persis- tance of physical symptoms.
Psychiatric and somatic symptoms in depressive disorders: approach to treatment
MAURI, MAURO;
2006-01-01
Abstract
Depression is still underestimated, despite its high incidence, and its impact on sub- jective quality of life. To accurately diagnose and to adequately treat depression are still the key points to obtain a good response during acute phases and to reduce the risk of relapses/recurrences. Somatic symptoms (namely, headache, stomachache, on the back pain, etc.) may be precursors or prodromals of a depressive episode, preceding for years the onset of mood disorders. Nonetheless, their detection is complicated, because somatic symp- toms are often underestimated or misinterpreted. Physical symptoms are part of typical depressive symptomatology. Changes in en- ergy, sleep, neurovegetative functions and sexual activity are common during a ma- jor depressive episode. Nonetheless, special populations of patients may show only this aspect of depression. Cognitive symptoms of depression in the elderly or during childhood or adolescence are often “covered” by the presence of physical symp- toms; depressed mood or low energy levels are considered by the patient (and some- times by physicians) as the “obvious consequence” of enduring physical symptoms, that are disturbing, interfering with social adaptation and thereof producing signif- icant levels of impairment. The accurate detection of all the aspects of a mood disorder is the first step, espe- cially in special populations of patients (elderly, childhood, pregnant women, etc.). Early detection of mood liability, mood instability, low energy levels, diurnal vari- ations, loss of interest and pleasure is fundamental for a correct diagnosis. Some- times, patients are closely focused on physical symptoms and tend to explain every other psychological manifestation as a consequence of the loss of subjective well- being. The aim of our observation is to reconsider the importance of a complete psy- chopathological assessment of patients with physical/somatic complaints. This is im- portant for two main reasons: 1) to consider physical complaints as a part of a more complicated syndrome; 2) to achieve as a treatment goal, a remission and not only a reduction of frequency or intensity of these symptoms. Findings from the literature show that physical symptoms may precede and follow ma- jor mood episodes, and may contribute, as residual manifestations, to increasing the risk or relapse or recurrence. Our aim is to consider as a new treatment option, these drugs that seem to be as equally effective on mood as on physical symptoms (SNRI). A new SNRI (duloxetine) seems to be useful in order to improve mood symptomatol- ogy during acute major depression episodes and to reduce distress due to the persis- tance of physical symptoms.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
