Though the hall­mark symp­toms of de­pres­sion are emo­tion­al (such as feel­ings of sad­ness and hope­less­ness,) de­pres­sion may al­so come with phys­i­cal symp­toms, in­clud­ing nau­sea, di­ar­rhea, pain, and weight changes. Too of­ten, how­ev­er, peo­ple sim­ply dis­miss these health is­sues or fail to seek prop­er treat­ment be­cause they don't re­alise what's go­ing on. "I've had folks who were re­ferred to me by the ER be­cause that's where they went for their symp­toms," says Robin Haight, PsyD, a psy­chol­o­gist in pri­vate prac­tice in Vi­en­na. Don't ig­nore pos­si­ble phys­i­cal symp­toms of de­pres­sion: Pain and oth­er changes in your health can ac­tu­al­ly be the first signs of de­pres­sion, and know­ing about pos­si­ble phys­i­cal ef­fects of de­pres­sion may help you get di­ag­nosed and treat­ed ear­li­er.

Di­ges­tive prob­lems

Stom­ach prob­lems are com­mon in peo­ple with de­pres­sion or anx­i­ety, es­pe­cial­ly in chil­dren and ado­les­cents. "Lots of kids have tum­my prob­lems and when you look in­to them, you find they're of­ten re­lat­ed to school anx­i­ety or their peer re­la­tion­ships," Haight says. Adults with de­pres­sion al­so may have di­ges­tive is­sues, such as queasi­ness, nau­sea, and di­ar­rhea. Some di­ges­tive dis­or­ders, such as Crohn's dis­ease, col­i­tis, or ul­cers, can be wors­ened by stress and de­pres­sion.

Headaches

Headaches can have many caus­es, and some­times they can be signs of de­pres­sion. Headaches that are re­lat­ed to de­pres­sion are usu­al­ly dull and gen­er­alised. Al­so, peo­ple with de­pres­sion of­ten re­port their headaches are worse in the morn­ing and in the evening. They are like­ly ten­sion headaches, which oc­cur when the mus­cles in your neck and scalp be­come tense or con­tract. "When peo­ple are de­pressed, they may be tens­ing this mus­cle group-not re­al­is­ing it and cre­at­ing a lot of head pain," Haight says.

Prob­lems sleep­ing

Trou­ble sleep­ing is one clue to di­ag­nos­ing de­pres­sion. Peo­ple with de­pres­sion can have dif­fi­cul­ty falling asleep or they may wake up in the mid­dle of the night and can't get back to sleep. "Every­one has stress and can't sleep now and then," Haight says. "But if your prob­lems sleep­ing go on for more than a few weeks, you need to start think­ing about whether it's an emo­tion­al dif­fi­cul­ty that needs to be ad­dressed." About a third of peo­ple with de­pres­sion may sleep much more than nor­mal

Back or mus­cle aches

Back or mus­cle aches can be an­oth­er phys­i­cal sign of de­pres­sion. "There's a re­la­tion­ship be­tween how well peo­ple take care of them­selves and de­pres­sion," Haight says. "Peo­ple with de­pres­sion tend to ex­er­cise less and are less like­ly to fo­cus on healthy eat­ing. When you don't treat your body in the most health­ful ways, you may have more phys­i­cal pain, pos­si­bly in your back and mus­cles or joints." Al­so, if you're al­ready liv­ing with any kind of chron­ic pain, de­pres­sion can make it worse.

Ex­haus­tion and fa­tigue

Ex­haus­tion and fa­tigue or lack of en­er­gy are clas­sic hall­marks of de­pres­sion, Haight says. De­pres­sion and fa­tigue tend to feed off each oth­er, so much so that in many peo­ple with de­pres­sion, it's hard to say what came first, their de­pres­sion or their fa­tigue. When peo­ple treat their anx­i­eties and de­pres­sion, "it's amaz­ing how much more alive they feel and how much more en­er­gy they have," Haight says. Changes in Ap­petite

Are you eat­ing too much and gain­ing weight? Or have you lost in­ter­est in food and are los­ing weight? Any change in ap­petite can be a sign of de­pres­sion. "Peo­ple of­ten use food to deal with emo­tion­al stress and feel­ings of sad­ness," Haight says. If your change in ap­petite lasts for more than a few weeks, talk to your doc­tor to find out if it's re­lat­ed to de­pres­sion or an­oth­er med­ical prob­lem-or both.