Wherever there is depression, there is fatigue and pain & wherever there is fatigue and pain, there is depression.

       Depression is a great mimicker and, like a chameleon, it can camouflage itself beyond recognition.  Most depression sufferers don’t look depressed to the casual eye but they are recognizable by their fatigue and pain.  Their pain may be emotional, physical, or both and their fatigue is pervasive, affecting all the functions of life.  Their submission to fatigue and their intolerance of pain are characteristic traits.  They are trapped in a vicious cycle where depression invites fatigue & pain and, in return, fatigue & pain invite depression.
      Depression and Anxiety are competing siblings on opposite ends of a seesaw; some times, Depression predominates; other times, Anxiety predominates; and most of the time, they coexist in a dynamic, up-and-down state.
      The physical signs of Depression are numerous and tend to defy diagnosis.  Patients complain of fatigue, abdominal pains, constipation, diarrhea, back aches, headaches, muscle aches, poor sleep, excessive sleep, weight gain, weight loss, shortness of breath, chest pains, palpitations, joint soreness, hair loss, irregular menses, etc.  They have weakened immunity, which makes them vulnerable to all sorts of common colds and other infections. They see many doctors for many symptoms but seldom obtain long-lasting relief with any symptomatic treatment.
      Their friends, coworkers, relatives, and families, complain about their poor productivity, inefficiency, irritability, anger, faultfinding, intemperance, intolerances, criticisms, aggressiveness, and their inability to get along with well meaning others.  Even their best friends begin to avoid them because of their unpleasant natures, their tendencies to argue, accuse, and spoil everyone else’s fun.
      In the brain, Depression can be viewed with special scanners that recognize increased nerve-cell metabolism.  These Positron Emission Tomograms or PET scanners reveal the metabolically excited nerve-cells in the Limbic System of the brain, and it is these exited brain nerve-cells that are the signature of Depression.  When Depression is treated, these metabolically excited brain nerves return to their normal state and are no longer highlighted by the PET scanner.  The PET scanner can also differentiate between Depression and Dementia because in Dementia, the brain suffers from lack of excitement, which is the opposite of Depression.  This distinction is critical in the depressed elderly because their behavior might very closely resemble that of Dementia.  The significant difference is that Dementia is a progressive and ultimately fatal disease while Depression is treatable and often curable.  Because depressed patients first present to their primary care specialist, most of them will end up being treated by their primary care specialist.  The primary care specialist is well trained to recognize the physical signs of Depression and is perfectly capable of treating the disease.  Only the resistant cases will need referral to a psychiatrist.          
      The medical treatment of Depression relies on a group of medicines called antidepressants.  There are several kinds of antidepressants and the primary care specialist knows how to choose the best one for each patient.  Antidepressants are not happy pills or mood-altering drugs; they work by replenishing the brain hormone deficiencies that cause the brain’s metabolic excitement.  It is this nonstop metabolic excitement that finally exhausts the brain and causes the disease we recognize as depression.