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Why Does Depression Hurt Physically?

On a neurochemical level, your emotional pain and your physical pain aren’t too different

In my experience, depression feels both literally and figuratively like being run over by a Zamboni. Depression makes people feel flattened emotionally, but it can also hurt like hell physically, manifesting in muscle pain, gastrointestinal issues and headaches. Why is it that a mental health issue can have such direct bodily side effects?

Unfortunately, like the causes and cures of depression more broadly, we don’t yet have a singular answer. We do know, however, that the link is real. Per a 1994 study of 1,000 primary-care patients, citing a physical symptom more than doubled the likelihood that the patient also had a mood disorder. In a 1999 study of 1,164 patients who met the criteria for depression, 69 percent initially made contact with their doctor only to address a physical issue, unaware of their potential depression diagnosis. 

One common theory behind this link is that both pain and depression are influenced by the neurochemicals serotonin and norepinephrine, because they both share the same neurological pathway. When a person experiences pain from an outside source, like banging their shin on the coffee table or getting a paper cut, the pain is moderated by these neurochemicals. Because depression is typically marked by an imbalance of these chemicals, it’s possible that this imbalance further contributes to feelings of physical pain. Similarly, it’s thought that the serotonin imbalance in particular can lead to a variety of gastrointestinal issues, because serotonin is primarily produced and stored in the gut

The benefit of this theory is that treating depression and the physical symptoms that accompany it can generally be achieved in the same manner. For example, when someone is prescribed selective serotonin reuptake inhibitors, the most common form of antidepressant, the medication will likely help with both mental and physical symptoms. According to data published by the National Center for Biotechnology Information at the U.S. National Library of Medicine in 2020, various studies show that between 40 to 60 percent of people prescribed antidepressants noticed an improvement in their physical symptoms within two months. 

Some theories behind the link assert that perhaps the depression is actually a side effect of the pain, rather than the other way around, or that people with depression have a lower threshold for pain. It’s also possible that depression produces inflammation in the body in the same manner as stress. Again, the precise answer isn’t known, and any and all of these theories might be true. Depression varies in many people, and the direct causes and effects of it often vary as well. Nevertheless, the aches and pains that accompany depression are indeed real and valid. 

The good news: While treating depression may take multiple attempts or more than two months for half of the population, remedying it and its side effects is still possible.

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