A body-mind map: epidemiological and clinical aspects of the relation between somatic, depressive and anxiety symptomatology

Many persons with a depression or anxiety disorder also experience somatic symptoms like back ache or dizziness. Although it is well-known that these symptoms mutually influence each other and can respond to the same therapies, only little is known about the roles of individual symptoms in this relation. This is the result of a tendency to focus on groups of symptoms in research: feeling down is in this way considered to be interchangeable with anxiety and insomnia. However, these symptoms have highly differential characteristics. Having more insight into these characteristics could help to understand how people develop specific symptoms and how they can be treated most effectively.
Ella Bekhuis investigated in her thesis the role of individual symptoms of depression, anxiety and the body. By using a novel method (‘network analysis’), a map was constructed that showed how dozens of symptoms were connected to each other. Each symptoms had a unique role in relation to other symptoms on this map. Anxiety, for instance, strongly increased the risk that someone felt down, while insomnia increased this risk only slightly. This map indicated the importance of taking into account such unique characteristics in research and practice to understand the relation between these symptoms.
It was also examined how the map of symptoms was affected by treatment with antidepressants and/or psychotherapy. Each symptoms responded in a different way to these therapies. Anxiety showed for example a greater improvement after treatment with antidepressants than with psychotherapy, while no difference was found between the therapies for insomnia. Feeling down, on the other hand, seemed to respond better to antidepressants, but only because it showed a simultaneous improvement with other symptoms like anxiety. Based on the symptoms patients experienced before treatment, it could be predicted which therapy would be most effective for them. Taking into account the unique roles of individual symptoms can therefore help to personalize treatment in psychiatry.