INTEGRATING CARE: DEPRESSI… 11

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Understanding
symptoms
155 comments

We learned in the last step that the mind and

body are inseparable and in constant
communication. Our physical health affects
our thoughts and feelings, and our thoughts
and feelings impact our body and physical
sensations. Understanding how the link
between mind and body shapes our
experience of symptoms may help us manage
them more effectively.

Here we consider how thoughts and feelings can

contribute to the onset or exacerbation of
common physical symptoms.

A racing heart

Our hearts can beat faster for many reasons. It

is natural for our hearts to beat faster when we
exert ourselves. Depending on how fit you are,
you may be aware of this even after quite mild
exertion, like climbing up the stairs. Caffeine can
also increase the heart rate, and you may notice
this after a cup of strong coffee. Anxiety or fear
can increase our heart rate and raise our blood
pressure. This is part of the ‘fight-flight’
response – the body’s natural response to
perceived danger. During this physiological
reaction, blood flow to major muscle groups is
increased, providing extra strength and speed to
run away or fight the threat. You may also notice
your heart pounding when you are excited - and
it really is true that falling in love makes our
hearts beat faster. Falling in love causes the
adrenal gland to release the hormone
norepinephrine, which interacts with beta
receptor cells in the heart, increasing the rate at
which they generate electrical charges and
causing the heart to contract more rapidly.

Fatigue

Fatigue is another complex symptom affected

by both physical and mental factors. Nearly all
physical illnesses can cause fatigue. Fatigue is
also a side-effect of many medications - for
example, antihistamines for allergy, beta-
blockers to reduce blood pressure, cancer
treatments and opioid pain medications.
However, fatigue is also affected by how we
think and feel. Fatigue is a very common
symptom of depression. Anxiety can keep us
awake at night, leaving us tired the next day. It
can also activate our stress hormones (eg
adrenaline and cortisol) and make our muscles
tense, both of which can reduce our energy
levels over time. When we are on edge, we may
also become less effective at pacing ourselves,
so that we do not make the best use of our
energy. Fatigue experienced in the context of a
chronic health problems is most often a
combination of physical and emotional factors.

Shortness of breath

Shortness of breath can be connected to health

conditions like asthma or chronic obstructive
pulmonary disease (COPD), but it can also be
triggered by physical exertion or anxiety. Even if
initially caused by a physical problem,
breathlessness will be made worse by anxiety.
Not being able to catch your breath can be very
frightening. As with any symptom, the more you
have an anxious focus on it, the worse it feels.
With breathlessness, there is an added problem:
anxiety can make us breathe more quickly and
shallowly. It can also cause muscle tension
around the chest, which can make breathing feel
more difficult.

Itch

We can feel the sensation of itch and the urge

to scratch because of physical health problems -
for example, liver disease or an allergic reaction.
However, our skin can crawl simply because a
particular thought goes through our minds. For
example, right now, you could try thinking about
a spider crawling across your skin. Another
factor is that if we repeatedly scratch the same
place, the skin can get irritated, which can make
us feel more itchy rather than less. In this way,
we can get into a vicious cycle of itching and
scratching. There is extensive evidence that
psychological distress can trigger or exacerbate
skin diseases which cause itch, such as eczema
and psoriasis. The relationship between
psychological and dermatological health is
complex and bidirectional – having psoriasis, for
example, increases the risk of depression, and
depression increases the severity of psoriasis.
Psychological distress activates the body’s
stress response system (the autonomic nervous
system (ANS) and the hypothalamic-pituitary-
adrenal (HPA) axis), which then interact with the
immune system to cause inflammation. These
inflammatory processes are linked to the onset
and severity of both skin disease and
depression.

Pain

Our experience of pain is not just physical but

affected by many factors. The pain signals which
travel along the nerves to the brain get stronger
or weaker depending on how important we think
they are, and how many other things are calling
for our attention. Depression and pain are
intertwined and can interact in a vicious cycle:
pain can lead to depression and depression can
magnify pain. Depression and chronic pain share
biological mechanisms (e.g. heightened
inflammatory response). People who are
depressed tend to experience more intense and
more persistent pain than other people. Chronic
pain can cause neurochemical changes in the
body which over time increases the brain’s
sensitivity to pain.

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COMMENTS

Louise Ferri

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Show: All comments Sort by: Newest

KC Kath C Follow 31 AUG

Really well presented. From my experience,older

people seem to deny that they could be or are
depressed, and the impact this haves on their
well being.Maybe, there needs to be more
education about this connection.
It is a sad fact, that a lot of medications cause
fatigue, and this can lead to other perceived
problems which require a solution (often in the
form of more medication)

CA Carolyn Amos Follow 24 AUG

It's good that the two are being looked at and

their interconnectedness recognised. Hopefully
more education around this will help GP's and
other allied health professionals to better treat
the whole person.

CD Carolyn Dow Follow 21 AUG

Very good articles and informative module

Beck L Follow 20 AUG

This was very interesting to read and I could

relate very much to two of the examples above
in particular: shortness of breath and pain.
During the time of COVID, and with respiratory
concerns a major symptom of the disease, I have
noticed lately that if I feel even a little out of
breath (unusual for me, as an athlete), I start to
freak out ... "Oh no! I have COVID!" -- and of
course, these kinds of thoughts exacerbate the
problem even more. When I remind myself it's
unlikely that I have COVID, I calm down and I
find my chest and breathing relax as a result.
Pain is another one and reading this I'm
reminded of my high pain threshold -- does this
mean my pain receptors are different to those
who experience more physical pain than I ... or
do I simply view pain differently through the
thought processes I associate with it ("this will
be over soon...", "just count to 10...", "I can get
through this...", "this doesn't really hurt, it's all in
my head...")?

SH Syed Haider Follow 09 AUG

This is very interesting topic, physical and

mental condition are of our body therefore can
not be seen separately as we are ‘A Person’ if
one state or function of a body goes wrong it
effect the whole person.

SP Sarah-Jane P Follow 31 JUL

I didn't know that pain is affected by how

focused we are on it. I'm a wimp when it comes
to pain, I reach for the painkillers and don't
move if it's that bad.

I've always had fatigue, for my whole life. I was

assessed for ME as a teenager, but they couldn't
say one way or another because of my existing
disabilities. I always feel tired and have never
identified a cause for it, though it probably
could be lots of things. It doesn't seem to
matter if I get a good night's sleep (which isn't
happening while I've gone nocturnal again), I still
wake up feeling tired.

I've fairly recently started having breathing

problems related to stress/anxiety. It's really
bad timing with Covid-19 around, to keep feeling
like I can't breathe. I tighten my muscles in my
side and can't relax them, and breathe too fast
and shallow, and I have to sit back or lie down
to be able to breathe properly. It can happen
repeatedly some days, other days not at all. I'm
still not sure what triggers it.

JG Jacob Goh Follow 29 JUL

The article is very interesting and informative. If

a person knows and understands their
symptoms they will better be able to help
themselves with self-care. For healthcare
professionals, they will be better informed and
can tailor their care to the specific
circumstances and deliver the best outcome.

BA Bridget Awogboro Follow 29 JUL

Very Helpful

MK Mala Kumari Follow 28 JUL

There's are many symptom which can be

increased or decreased by our thought and
feelings . Some of them are a racing heart,
fatigue, shortness of breadth, itching and pain.
So we have to be. More careful with our mental
well being along with remedy of physical illness.

LE Leah Edgar Follow 28 JUL

Very informative and relatable for someone who

does suffer from mental health problems!

GM Gerard mitchell Follow 28 JUL

In my area and common to many, at the time of

the clap for NHS, I asked an active young person
to devise a 5 minute exercise program tailored
for the over 60s the majority in the area. After
initial resistance all enjoyed it bringing
community and health together. Lock down to
many has brought a coming together including
those perhaps initially isolated. Will it last with
its benefits?

LO Lauren Osborne Follow 27 JUL

We need to gain better control of our emotions

and our relaxation to improve both physical and
mental health complications and achieve a
better quality of life.

BB bronwyn B Follow 27 JUL

Maybe as a communities we also need to be

better educated about the interconnectedness
of depression and chronic pain - to lesson the
amount of judgement! (public awareness
campaign). This section has certainly opened my
eyes esp that depression and chronic pain share
the same neurotransmitter. Its a vicious cycle
that pain can lead to depression and that
depression can magnify pain. So it makes sense
that they be treated concurrently.

AF Antonieta Fostier Follow 25 JUL

Perfect.

Karla Martinez Follow 23 JUL

Makes me realize that’s I have been missing the

psychological aspect of my chronic illness. And I
need to add a psychologist/ counselor into my
list of specialists.

LT Louisa Tsang Follow 21 JUL

The more we understand about our

psychological and physical health are
intertwined and one affects each other, we will
be more relax and try to find methods to relax
and not just to focus on our physical symptoms.
We will feel happier and enjoy our lives.

Alison Bush Follow 16 JUL

Information especially links to articles very

useful and informative enjoyed reading. I have
experienced skin rash blistering and similar
issues following traumatic events on several
occasions suggesting definitely for me there is
association between my perception of stress
anxiety and skin issues. I have been referred to
dermatology clinic for skin issues and told my
problems were stress related. Although I didn't
agree with diagnosis at time presumably
because I lacked necessary insight into my
depressed mood state probably dermatology
was correct. Stress urticaria experience often.
Pain is not often experience by me ?? related
autism

Shirley Stewardson Follow 20 JUL

totally the same here Alison, I come out

with blisters on my arms and after
reading this I too feel there is a
association with my mental health and
outbreaks.

Add a reply...

JG Juliana Gómez Follow 15 JUL

What important role does our mind have with

our body?

Author Emiliya Ahmadova Follow 14 JUL

An eye opener

Georgina del Pilar Nieto Follow 14 JUL

Valdivieso

Todo nuestro cuerpo reacciona a nuestras

emociones.

AM Amanda Mitchell Follow 14 JUL

the link is impressive. It makes sense that

everything in our body works together

SK susan king Follow 14 JUL

mind body connection is very strong, I tried for

10 years for a baby,, had no obvious reasons not
to get pregnant and after 10 years decided to"
change my view and "get on with life", Then yes
you know my next line i did get pregnant and
had a baby boy and 21 months later had another
baby boy, now 2 teenagers 17 and 19.

Alison Bush Follow 16 JUL

Good to know congratulations

Add a reply...

ED Emma Douglas Follow 14 JUL

I find this fascinating! I am applying to train to

be a psychological wellness practitioner and
these links will be invaluable for me to be able
to help and more crucially understand my
clients.

LH Lorraine Hunt Follow 13 JUL

Fascinating to read direct correlations between

the mind and body and that they are
inseparable and in constant communication.
Physical health affects mind and thought and
negative thoughts have a direct impact on the
body. I have anxiety and know only too well the
physical effects on my body. I really need to be
aware of my thoughts and my reactions and the
way I react to everyday situations. As its
something I've always done, I feel this is me, but
if I can be aware of my reactions and try to
change these automatic reactions, it's a
challenge I really need to get on top of.

Wendy Perkins Follow 13 JUL

It is good to know the symptoms, so you can

recognize what your trying to deal with

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