Whilst conditions, such as fatigue, insomnia and poor appetite are known symptoms of depression in primary care, traditional teaching indicated that these somatic symptoms of depression should be ignored in medical settings if they are assumed to be associated with physical illness.
Researchers from the University Department of Cancer Studies and Molecular Medicine assessed 279 patients, up to three times after their cancer diagnosis, for somatic and non-somatic symptoms, of which 31% were in a palliative stage.
The researchers diagnosed depression by self-report PHQ9 and HADS-D scales, as well as by using DSMIV criteria, and discovered that the most accurate diagnostic symptoms for broadly defined depression were all somatic, such as having either difficulty sleeping or sleeping too much, feeling tired or having low energy, low appetite or overeating, concentration problems on things like reading.
When they investigated severe major depressive disorders (MDD), they found that both somatic and non-somatic symptoms were relevant, although “low energy” was poorly discriminating. They found the symptom “moving or speaking slowly” to be less influential amongst palliative patients. However, other somatic symptoms, like poor appetite or overeating and feeling tired or having little energy were valuable.
Dr. Alex Mitchell, a consultant psychiatrist with the Leicestershire Partnership NHS Trust and a researcher at the University of Leicester, explained:
“Cancer clinicians should therefore be careful about attributing somatic symptoms of depression to cancer itself. This even applies in the later stages of cancer. Depression scales that exclude all physical symptoms may not be the optimal choice in cancer patients.”
Written by Petra Rattue