Depressive psychosis presenting as chronic pain disorder

Depression can be disguised by somatic symptoms, chronic pain, hypochondriacal or psychosomatic disorder. The predominant somatic presentation may render such cases to be misdiagnosed, wrongly investigated and treated. In this study 30 consecutive patients diagnosed as MDP Depression, who lacked sadness but presented with chronic pain have been described. The patients were mainly female, middle aged and from urban background. Pain, usually at multiple sites, was reported to be severe by most patients. Predominant depressive symptoms were lack of interest in surrounding (97%), though this was not directly reported, early morning a wakening (87%), loss of appetite (93%), suicidal ideas (67 %). None had marked sadness or weeping spells. Lack of reactivity of mood was present in only two cases. The clinical implications of such patients is discussed.