From the Guidelines
Patients with depression often exhibit physical exam findings such as psychomotor retardation or agitation, poor eye contact, flat affect, and decreased facial expressivity, as supported by the diagnostic criteria for major depressive disorder 1. These findings can be subtle and vary widely among individuals, but they may include:
- Poor self-care and hygiene, appearing disheveled
- Vital sign changes such as tachycardia or alterations in blood pressure due to anxiety components
- Neurological examination findings like psychomotor slowing, with delayed responses to questions and slow movements
- Signs of weight loss or gain resulting from appetite changes
- Cognitive examination revealing poor concentration and slowed thinking
- Physical manifestations of self-harm, such as cutting marks or healed suicide attempt scars, in some cases
- Sleep disturbance effects, apparent through dark circles under the eyes or general fatigue It is crucial to consider these physical exam findings in the context of the diagnostic criteria for major depressive disorder, which includes symptoms such as depressed mood, loss of interest or pleasure, significant weight loss or gain, insomnia or hypersomnia, and fatigue or loss of energy, as outlined by the American Psychiatric Association 1. The presence of five or more of these symptoms within a two-week period, with at least one being either depressed mood or loss of interest or pleasure, is required for a diagnosis of major depressive disorder 1. By considering both the physical exam findings and the diagnostic criteria, healthcare providers can establish an accurate diagnosis and develop an effective treatment plan for patients with depression.
From the Research
Physical Exam Findings in Depression
The physical exam findings in a patient with depression can include:
- Retardation of movements and diminished gestures and expressions 2
- Appearance of being tired, self-concerned, bored, and inattentive 2
- Loss of interest in surroundings 2
- Anxiety, which may be expressed by severe restlessness and agitation 2
- Muscle tension, wringing of hands, weeping and moaning, repeating over and over in a monotonous and stereotyped way phrases expressive of misery 2
- Tachycardia, dry tongue/mouth, sweaty palms and/or bodily extremities, cold clammy skin, pallor, pupillary dilatation, tremor, and fluctuations in blood pressure with wide pulse pressure 2
- General fatigue, sleep disturbance, and appetite loss, which are common symptoms in patients with depression 3
Correlation between Physical Symptoms and Depression
There is a high correlation between the number of physical symptoms and the presence of depression 3. Patients with depression often report multiple physical symptoms, and the prevalence of depression increases with the number of symptoms 3. In fact, when patients have neither general fatigue, nor sleep disturbance, nor appetite loss, none meet the criteria for depression 3.
Importance of Physical Exam Findings
The physical exam findings in depression are important and can help clinicians diagnose and assess the severity of the illness 2. These findings have been incorporated into various rating scales, such as the Hamilton Depression Rating Scale and the Montgomery-Asberg Depression Rating Scale 2. However, the current practice of operational criteria does not always include these physical signs as an integral part of the clinical picture of depression 2.