What are the common neural vegetative symptoms of depression, including insomnia, fatigue, low energy, inattentiveness, increased appetite, and weight gain?

Common Neurovegetative Symptoms of Depression

The core neurovegetative symptoms of depression include insomnia (or hypersomnia), fatigue and low energy, appetite changes (typically decreased, but sometimes increased), weight changes, and psychomotor changes—while inattentiveness is better classified as a cognitive symptom rather than a neurovegetative one. 1, 2

Neurovegetative Symptoms Defined

Neurovegetative symptoms represent the physical, somatic manifestations of depression that reflect disruption of basic biological functions. According to the American College of Physicians and the American Psychiatric Association, these include: 1, 2

Sleep Disturbances

• Insomnia or hypersomnia are both recognized neurovegetative symptoms 1, 2
• Sleep change is one of the most common symptoms in major depressive disorder, appearing in the majority of cases 3
• The American College of Physicians specifically lists "insomnia or hypersomnia" as a criterion symptom 1

Energy and Fatigue

• Fatigue and low energy are classic neurovegetative symptoms 1
• Loss of energy is among the most common symptoms in major depression 3
• Fatigue in depression is characterized by low energy, tiredness, and weakness 2
• Post-stroke depression guidelines specifically note that "neurovegetative symptoms of depression, including sleep disturbance, decreased appetite, fatigue, and feelings of hopelessness" are frequently seen 1

Appetite and Weight Changes

• Appetite changes can occur in either direction—both decreased and increased appetite are recognized 1, 4
• The American College of Physicians defines this as "significant weight loss or gain or appetite disturbance" 1
• Increased appetite and weight gain represent "atypical" or "reversed" neurovegetative features 4, 5
• Approximately 11.3% of individuals with major depression experience only reversed symptoms (hypersomnia, hyperphagia, weight gain) 5
• Decreased appetite is more typical, but increased appetite is a valid neurovegetative presentation 4, 5

Psychomotor Changes

• Psychomotor agitation or retardation are neurovegetative symptoms 1, 2
• These represent observable changes in physical movement and activity 1

Cognitive vs. Neurovegetative Symptoms

Inattentiveness is NOT a neurovegetative symptom—it is a cognitive symptom. 1, 2

• The American College of Physicians lists "diminished ability to think or concentrate or indecisiveness" as a separate criterion from neurovegetative symptoms 1
• The American Psychiatric Association distinguishes between somatic/neurovegetative symptoms and cognitive symptoms like concentration difficulties 2
• Neurovegetative symptoms specifically refer to disruptions in basic biological functions (sleep, appetite, energy, psychomotor activity), not cognitive processes 1

Clinical Assessment Considerations

Common Pitfalls

• Do not confuse neurovegetative symptoms with depression itself in medically ill patients 1
• In post-stroke patients, "neurovegetative symptoms of depression, including sleep disturbance, decreased appetite, fatigue, and feelings of hopelessness, are similar to common poststroke symptoms," leading to underdiagnosis 1
• In cancer patients, "vegetative symptoms such as fatigue and anorexia are common as a consequence of the disease," making depression assessment challenging 1
• In multiple sclerosis patients, neurovegetative symptoms may reflect disease-related fatigue rather than depression 6

Assessment Tools

• The Hamilton Rating Scale for Depression (HAM-D) specifically assesses domains including "low mood, insomnia, agitation, anxiety, and weight loss" 1
• The Beck Depression Inventory includes "behavioral, cognitive, and somatic components of depression" 1
• The Center for Epidemiological Studies Depression Scale (CES-D) is "relatively unaffected by presence of physical symptoms," making it useful when neurovegetative symptoms may have multiple causes 1

Answer to the Multiple Choice Question

Select the following as neurovegetative symptoms:

• ✓ Insomnia 1, 2
• ✓ Fatigue and low energy 1, 2
• ✓ Increased appetite and weight gain (atypical/reversed neurovegetative features) 4, 5

Do NOT select:

• ✗ Inattentiveness (this is a cognitive symptom, not neurovegetative) 1, 2