gastrointestinal problems, tiredness, sleep disturbances, psychomotor activity changes, and appetite changes. A high percentage of patients with depression who seek treatment in a primary care setting report only physical symptoms, which can make depression very difficult to diagnose. Physical pain and depression have a deeper biological connection than simple cause and effect; the neurotransmitters that influence both pain and mood are serotonin and norepinephrine. Dysregulation of these transmitters is linked to both depression and pain. Antidepressants that inhibit the reuptake of both serotonin and norepinephrine may be used as first-line treatments in depressed patients who present with physical symptoms. Many physicians consider patients to be in remission when their acute emotional symptoms have abated, but residual symptoms—including physical symptoms—are very common and increase the likelihood of relapse. All symptoms must be measured in order to achieve full remission. There are a number of short yet accurate measurement tools (rating scales) available that effectively measure the remission of physical symptoms as well as emotional symptoms.

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(Prim Care Companion J Clin Psychiatry 2004;6[suppl 1]:12–16)
From the University of Texas Southwest Medical School,
Dallas.
This article is derived from the teleconference “New
Treatments for Depression Characterized by Physical
Symptoms,” which was held May 15, 2003, and supported by
an unrestricted educational grant from Eli Lilly and Company.
Corresponding author and reprints: Madhukar H. Trivedi,
M.D.,