Physical symptoms comorbid with depression and the new antidepressant duloxetine

Most general descriptions of depression that date back to Hippocrates, including the DSM-IV, have listed gastrointestinal problems, sleep disturbances, headaches, appetite changes, and aches and pains of a diffuse nature as common features of the disorder. In addition, physical symptoms have a strong association with psychiatric disorders, and the presence of any physical symptom may increase the likelihood of a mood or anxiety disorder by two-fold or three-fold. A growing body of evidence suggests that serotonin and norepinephrine may share neurochemical mechanisms that tie depression and physical symptoms together. Both selective serotonin reuptake inhibitors alone and antidepressant agents that incorporate both serotonin and norepinephrine reuptake inhibition have shown evidence of relieving physical symptoms. Given the additional disease burden caused by physical symptoms in depression, it is vital that antidepressant agents that effectively treat the physical symptoms and chronic pain associated with depression be used.