Psychological disorders are well-defined and well-studied categories. Of these categories we know important data such as the affectation it has among the population, its causes, the treatments that work best for the disorder in particular, etc. In the definition of these disorders we also necessarily find the symptoms that compose them.
Sometimes, however, the disorders may manifest in a different way than usual, with symptoms that are considered atypical for these disorders. An example of this is what is known as "masked depression", an atypical form of depressive presentation. In this present Psychology-Online article, we expose this particular form of presentation of depression: Masked Depression: What It Is, Causes, Symptoms And Treatment.
The Psychological Dictionary of the American Psychiatric Association (APA)[1] defines masked depression as a condition in which the person experiences a major depressive episode and manifests physical complaints such as headaches or back pain instead of referring to mood alterations, more common in this disorder. This is why masked depression is also called somatized depression. In the following article we explain in depth
Although the patient refers to physical complaints, no biological causes are found for these symptoms. However, the patient does not attribute his symptoms to depression, but to a physical illness. It is, therefore, the depressive disorder itself that is causing the physical symptoms.
It is a type of depressive manifestation that is not very frequent in the population. Following Shetty, P., Mane, A., Fulmali, S., & Uchit, G. (2018)[2], masked depression accounts for 6 to 7% of depressive disorders and between 30% and 40% of patients seek medical advice. However, in the publication of Artiles Pérez, R. and López Chamón, S. (2009)[3] state that it is precisely the somatic presentation that occurs the most in primary care consultations.
Regarding these data, the fact that depression manifests itself in an atypical way leads to it being an underdiagnosed phenomenon and frequently confused with other medical conditions.
It is important to make clear that masked or somatized depression, as such, is not a psychological diagnosis. It is not included in the DSM-5 (APA) diagnostic classifications or in the ICD-11 (World Health Organization) classification. It is a way in which it manifests itself, as the APA dictionary of psychology points out[4], major depressive disorder, which is a diagnostic category included in the classifications.
Artiles Pérez, R. and López Chamón, S. (2009)[3] point out the importance of pain in masked depression since it is a very frequent symptom in this condition. In the same article, two hypotheses are proposed that try to account for why patients feel pain without a physical cause. Let's look at the causes of masked depression
- It is a pathophysiological mechanism by which low mood amplifies somatosensory sensations.
- A pattern of physical symptoms in the face of denial to recognize a depressive picture.
- Many patients with chronic pain have a depressive disorder, so the symptoms of both would be overlapping.
- Depressed patients also have less resistance to pain (due to its lowering of the nociceptive threshold).
- The pathophysiological and neurobiological mechanisms pain and depression share common traits.
The etiological theories related to depression can also help us to explain the origin and development of these types of conditions. Among them we find:
- Psychological theories as the theory of learned helplessness wave Beck's cognitive theory.
- Biological theories among which stands out the monoaminergic theory that supports a deficit of serotonin, dopamine and noradrenaline. In this article we talk in depth about Neurotransmitters involved in depression.
As we have already pointed out, the underlying disorder is a depressive disorder, whose typical symptoms (collected in DSM-5) are the following:
- To feel down.
- Loss or decrease of interest in all or almost all activities.
- Weight loss or gain.
- Insomnia or hypersomnia.
- Psychomotor agitation or retardation.
- Loss of energy.
- Feeling worthless or inappropriate or excessive guilt.
- Decreased ability to think or concentrate or make decisions.
- Recurring thoughts of death or suicidal ideas.
However, these typical symptoms may (or may not) be present to a greater or lesser extent in cases of masked or somatized depression. How does silent depression manifest itself? Among the atypical symptoms, but more typical of this type of depression, we can find physical symptoms. The symptoms of masked depression are:
- Pains: head, back, musculoskeletal, etc.
- Dizziness. In the following article, we explain the relationship between dizziness and anxiety.
- Dyspnoea: feeling of lack of air.
- Gastrointestinal symptoms: gastrointestinal tract disorders.
The authors also note sleep disturbances, lack of energy, appetite, and decreased libido, although this type of symptomatology is also frequent in the typical manifestation of depression.
If the underlying cause of the symptoms corresponds to a depressive disorder then it will be this that should be treated to mitigate these symptoms. However, the case should be supervised by a doctor to rule out the presence of an organic cause of the pain. (remember that it is a characteristic symptom of masked depression) and offer the best treatment for it.
Focusing on treating depression, we have well-established psychological, medical or psychiatric treatments.
Following Carrobles, J.A. (2014)[5] psychiatric treatment would consist of:
- Administration of drugs antidepressants. In this article we explain the Types of antidepressants and what they are for.
- Prescription of mood stabilizers.
- Electroconvulsive therapy. In the following article we talk about what is Electroconvulsive therapy and how it is used.
- Other techniques brain stimulation such as transcranial magnetic stimulation.
The cognitive behavioral psychological therapy it also offers good results for the treatment of depression. For this, the professional can use different intervention techniques such as:
- Behavioral activation or enjoyable activities program.
- Therapy problem solving.
- Beck's Depression Cognitive Therapy.
- Coping program of depression (Lewinsohn).
In addition to these, the interpersonal therapy It has also shown good results in the treatment of depression.
This article is merely informative, in Psychology-Online we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.
If you want to read more articles similar to Masked depression: what it is, causes, symptoms and treatment, we recommend that you enter our category of Clinical psychology.
Masked depression: what it is, causes, symptoms and treatment
