Physical Side-Effects of Depression

In the therapy sessions, we usually concentrate on the emotional and behavioural aspects of depression, since this is the area where we can work on change. The physical side-effects of depression, which used to even eclipse the emotional pain quite often, will go away too when the depression vanishes.
For a long time, however, I wasn’t aware that these two aspects – mental/emotional well-being and physical pain – were so closely related. I blamed my thyroid and the Hashimoto’s disease for feeling fatigued and for the memory problems I was experiencing, even if the lab results showed that my medication was perfectly adjusted. For all the other complaints, I saw three doctors in total who all diagnosed me with a variety of conditions which usually matched the most recent physical manifestations, but always ignored the full picture. Nobody suspected depression before I started having panic attacks, and even though I personally suspected a mental health problem earlier, all the symptom lists for depression I checked mentioned weight loss and sleeplessness, while I was (am) clearly overweight and slept much more than the average person: I always dismissed the self-diagnosis again on these grounds. Only at the hospital I learned that in chronic depression, weight gain and hypersomnia can occur too, as well as many other symptoms.

Today, I wanted to take inventory of the physical side-effects which one would not necessarily relate to depression and which I experienced over the course of the years.

Permanent or frequent complaints:

  • Muscle pain in the limbs: I’m not entirely sure when this started, but by spring 2009, I very often had severe pains in the muscles and nerves of my arms and legs. Sometimes it would feel like a “tennis arm”, sometimes like the kind of muscle cramps you get when over-exercising. I combatted the pain with ibuprofen, paracetamol or aspirin, which brought relief for a few hours.
    My second general physician diagnosed me with multiple sclerosis because of it.
    When I was put on an antidepressant in summer 2011, the pain went away after only four days. It returned after I discontinued citalopram; my therapist was the first person who told me that it was stress-related and caused by an inability to relax. Ever since, I lie down and try to consciously relax all of my body whenever I feel the pain. With the progress in therapy, the days when my limbs hurt become fewer and fewer.
  • Inflammation of the eyeballs: This symptom first occurred in spring 2009 too, when my eyes became red, dry and sensitive to light. In the beginning, the intensity would be sometimes less, sometimes worse, but last year, it was permanent.
    My first general practitioner diagnosed it as hay fever – never mind that weather or seasonal changes had no influence on it at all. My sister and niece both have hay fever, so I am rather familiar with its symptoms, and I was very certain that the inflammation of my eyes was not allergy-related. The next doctor saw it as a symptom of MS, together with the muscle pain.
    As with the muscle pain, the inflammation vanished when I started to take citalopram and returned afterwards. Recently, the inflammation had come back, but as I try to counteract the stress, it gets a little better every day.
  • Headaches: I used to have headaches very frequently; up to four or five times a week during the most intense periods. The most common form was a consistent, one-sided pain directly behind the eye, as if someone was relentlessly poking me into the eyeball from behind. In 70% of all cases, the left side was concerned. Rarely (once every couple of years), I will also have a case of migraines, when I can’t tolerate light and sound and have to lie down in a dark, quiet room with a wet cloth on my face.
    The headaches started very early, during my teenage years already, and currently occur on about two or three days per month.
  • Digestive problems: Another group of symptoms that I had since adolescence – stomach aches / cramps, diarrhoea, a couple of episodes when I couldn’t eat anything but apples and plain rice, one episode of histamine intolerance that vanished after two weeks. Now I experience those problems about 2 – 3 times per month, but during the worst of it, that would be 4 – 5 times per week, for months on end.
  • Backaches: For about twenty years, I used to have “typical” complaints like tense muscles around the shoulder and back of my neck, but in recent years, there have also been intense phases of lower back pain. The latter first occured early in 2008, about two weeks after I had started a new job that pushed me to the limit in regards to social anxiety. I didn’t make the connection back then, but in retrospect, it seems very clear that the job and the new type of backaches were related.

Infrequent or singular complaints:

  • Vertigo: One morning in 2007, I woke up with such a heavy case of vertigo that I literally couldn’t get out of bed. Lifting my head alone brought such waves of nausea that I had to vomit. It took three days until I could leave the house and see a doctor for it, who was clueless and referred me to a specialist. I had my ears and head checked, especially the sense of equilibrium, but everything was fine. They sent me home, “If it happens again, come back.” So far, there has been no second episode of unexplainable vertigo.
  • Chest cramps: This is a strange one. The first experience was the night after I celebrated my 18th birthday with a party; I woke up in the wee hours of the morning with a feeling as if my stomach was starting to petrify. Since then, I have spells when it happens a couple of days in a row, just to stop again just as suddenly for about half a year.
    Very often, the cramps come at night and I wake up from the pain, but sometimes they can also occur during the day: the muscles around my stomach become hard and cramp; a very intense ache that I feel under the sternum and in the middle of my back. Sometimes, I can sense the muscles there going tense a few hours before the actual cramping, but usually it happens within minutes only.
    Heat helps as it relaxes the muscles. At my most desperate, I had hot water bottles on both chest and back and was drinking hot water to relax the muscles from inside as well, because the pain can get so intense that I can hardly stand upright anymore and feel like opening my chest with a knife just so I can reach under the sternum and massage the muscle.
    Some people have suggested that it might be heartburn, but it feels completely different and is not inside the oesophagus or stomach, but very clearly outside of it.
    It appears that the chest cramps have become less intense and more infrequent, but is too early for making a definite call still: I had episodes of up to nine months without them and experienced some chest cramps this spring, so it will need at the very least a year without them before I consider them gone.

Do It Yourself

Even though it appears that my BDI-II score lingered in the same area since March, there has been a great shift when looking at the individual topics of the assessment. The points used to be evenly spread over a lot of categories, but out of the 11 points I scored on Monday, 7 resulted from somatic reactions to stress: fatigue, lack of energy, hypersomnia, inflamed eyes and muscle pain. They will go away or at least get better if I manage to reduce the stress and relax, but are not related to negative thought patterns.
That means only 4 points are left where we need to work on the way I perceive myself and the world around me: the most persistent over all those months has been the self-dislike category, where it took the longest until any change occurred at all, and where I have never been down to a score of zero. Currently, I rate myself as 1 – “I have lost confidence in myself”. Which is pretty good in my book already, but my therapist thinks it could be even better… He knows that I have strong tendencies towards ruminating over the past and constantly reminds me of staying in the present, “I did not notice anything in the last months that you should blame yourself for.”

A lot of things that used to be very difficult or intimidating have become a lot easier: I am not constantly obsessing over the camera which records our sessions (for documentation and supervision purposes) anymore – though I hardly ever forget that it’s there for longer than a few minutes. I also write the situational analysis on the flip chart myself now, which I always avoided, and even the dreaded role-playing exercises are not quite that bad anymore. For months, my therapist would ask, “Would you like to write on the flip chart?” And I would reply, “I’d rather not.” But now he’s changed to, “Why don’t you write on the flip chart?” And so I did, and it was ok.

I told him about the nice feedback I had received from a former colleague last week, and he emphasized that it was me who had put the new batteries into me, nobody else. According to the theory that depression is “learned helplessness”, people get depressed when they feel that it doesn’t matter what they do, they’ll fail or suffer afterwards anyway – one of the main focuses of CBASP is making you realize that your behaviour does make a difference.
He’s right in so far as nothing we did in therapy would be worthwhile if I didn’t apply it to my everyday life. I have worked hard on myself, and I worked for therapy too: doing my homework, being prepared, being very willing to work with my therapist and not against him.
I agree that the progress has been my doing, but I couldn’t have done it without professional help. After almost a year of most severe depression, I was so depleted that I couldn’t have helped myself even if I’d known what to do, and I also think without guidance, I might have given up trying soon. It was necessary to hand over the planning to someone else and trust that they’d know what to do. For the first three months, I just followed the lead until I was well enough again to even start thinking about how to take my life into my own hands.