Depression is one of the most common mental health conditions worldwide, and about 21 million adults in the U.S. have had at least one episode of major depressive disorder. Yet, if you ask someone to describe depression, they'll probably focus on symptoms like feelings of sadness and hopelessness. They might not think or even know about the physical symptoms, like sleep problems, changes in weight, low energy, or fatigue. Even pain can be a symptom, and it affects as many as 80% of people who have depression.
"A lot of times, we just think of depression as a mental side, but there are a lot of physical things going on when you experience depression and mental health," says Sharon Johnson, a 39-year-old mother of six and content creator, who has been living with depression most of her life.
"Depression can manifest first physically," says Ilana Cohen, MD, a psychiatrist at The Retreat by Sheppard Pratt in Baltimore. "[This can be] especially for someone who is not familiar with mental health language. They come to their primary care doctor with complaints of headaches, migraines, issues with digestion, fatigue, or muscle tension, for example. All of these symptoms can be physical or can be related to depression."
Johnson began seeing a therapist when she was 14 years old and started taking medication a year later. She knows the signs and how depression affects her body, not just her mind. "Really big for me [is] that [depression] makes me fatigued," she says. "It gives me body aches. It makes me anxious. It makes me irritable."
How Depression Can Show Up in Your Body
Pain. Pain is the most common physical symptom of depression. About two-thirds of people with major depression complain of "general aches and pains." One study showed that painful symptoms are responsible for disability in 41% of people with depression.
Sleep. People often recognize that depression can make you want to sleep more, but it affects sleep more than that. Depression can cause insomnia: inability to fall asleep, interrupted sleep (your sleep is broken), and waking too early, as well as oversleeping.
Weight gain/loss, appetite, and digestion. Some people eat more when they're depressed. Depression can cause cravings, but eating may also be a source of comfort. Depression can also make you eat less, maybe because of poor digestion or a "nervous stomach." There's a reason for this: a connection between your brain and your gut. Disruptions in the brain, like depression, can cause either unusual hunger, loss of appetite, indigestion, gas, diarrhea, constipation, and even nausea. So if your digestive system is off, you can end up losing weight unintentionally – or if you're unusually hungry, you'll gain it.
Lack of energy. Lack of energy or fatigue could be caused by difficulty sleeping and poor appetite, but it also might be caused by inflammation in your body.
Low sex drive (lack of libido). Having a low sex drive is common among people with untreated depression. You could lose interest in having sex, might not respond sexually as you used to, and/or may not be as satisfied. Again, there's a reason. Depression can cause your brain to slow down the neurotransmitter (messenger cells) it sends to your sex organs to prepare you for sex. If these are out of balance, your desire or response goes down.
Why It's Important to Recognize the Connections
Recognizing that depression can cause physical symptoms before they cause mental ones is important because not realizing this can lead to a delayed diagnosis, or maybe missing the diagnosis altogether. This is why people should speak with their doctors, telling them what is bothering them even if it might not seem like they're worth mentioning.
Many doctors have limited time with their patients. They focus on what you're telling them and what they can see. If you only talk about physical problems, whether it's pain, weight changes, a drop in sex drive, or something else, and don't mention mental health symptoms, it's easy to understand how a doctor might miss a depression diagnosis. A study published in 2023 found that over half of patients with depression were never formally diagnosed or treated, and this could be one reason why.
Researchers also found a connection to the amount of complaints and the risk of depression. The more physical symptoms someone has (sleep problems, fatigue, stomach issues, and pain), the higher their chances of having depression. And it goes both ways. As depression worsens, so do the physical symptoms. Studies have looked at the amount of pain someone might have and the risk of depression. People who had two or more different pain complaints were six times more likely to be depressed than people who didn't have pain. Those with three or more pain complaints were eight times more likely. But which causes which isn't really known.
"Depression can cause pain to worsen, or can cause pain and then pain can actually also lead to depression," Cohen says. "There's sort of a snowball effect there."
How severe the symptoms are and how long they last are also issues. The worse they are and the longer they last, the more severe depression is likely to be. While some doctors might not feel comfortable diagnosing depression, they can screen for it, particularly if a patient is complaining of multiple physical symptoms.
How Does Treating Physical Symptoms Help to Treat Depression?
It's important to look at what depression and physical symptoms have in common when talking about treatment because often, treating one will treat the other. Another thing to consider is the role of inflammation in your body. "There is a link between inflammation, which [may cause] damage and stress on the body, and depression," Cohen says. "Things that tend to be anti-inflammatory also have been shown to help with depression and mood and the physical symptoms." So there's no particular focus on dealing with one over the other – it's not a matter of choosing to treat your mood or your body. They look at the symptoms and decide what needs treatment first, but the same plan can help both mental and physical health.
Here are some steps you might take to help treat both depression and physical symptoms:
Take medications
Antidepressant medications have been around for a long time, and doctors have learned over the years that some have benefits beyond mood. Some are prescribed for physical symptoms. For example, serotonin and norepinephrine are chemical messengers in your brain. They are involved in both mood and how your body processes sensations like pain, energy levels, and sleep. So some people take antidepressant medications to manage chronic pain, irritable bowel symptoms, or even to help their appetite in extreme cases. And for those who start taking antidepressants for depression, studies show that many notice their physical symptoms improve during the first weeks of treatment, especially when their depression also starts to lift.
Eat a healthy diet
Eating a healthy diet has many benefits. Eating well can give you energy to fight fatigue. Healthy foods can improve your sleep, and can tackle inflammation, which can contribute to depression and physical symptoms.
Get physical
The idea of exercising when you're tired, uncomfortable, or depressed can seem too much. But if you look at it as just moving more, that might be something you can do. Physical activity can help reduce inflammation in your body, increase your appetite, reduce your stress levels, and improve your sleep.
Try to get more restorative sleep
Cohen says that sleep is important for both physical and mental symptoms. "Sleep gets disrupted when people are depressed or when they're anxious, and when you're not sleeping and you're tired, that's going to lower your desire to do anything else. We know that insomnia can then worsen the experience of pain, so try to build in a bedtime routine that's supportive of sleep."
Speak to a therapist
Speaking to a therapist, counselor, or psychologist can help ease depression, but it can also help you manage physical symptoms. "Psychotherapy can be quite powerful," Cohen says. "Cognitive behavioral therapy, for example, has really good data around pain management." This type of therapy also helps many people with insomnia and weight issues.
Finding the right kind of help for depression and physical symptoms caused by depression can take time. "I've seen and worked with a lot of people who are experiencing physical things that feel really, really impossible and difficult, and sometimes people can feel like their life has to be on hold or happiness is elusive until this thing is completely fixed," Cohen says. "But what we see is that there are a lot of modalities that can help people live a really happy, powerful, wonderful life, even if the physical symptoms don't go away completely."
