抑郁症躯体症状的临床表现与诊疗进展

Clinical Presentation and Therapeutic Advances of Somatic Symptoms in Depression

摘要: 抑郁症是一种常见的精神障碍，除情绪症状外，约三分之一至一半的患者以躯体症状为主要就诊原因，其识别与管理是临床实践中的关键问题。本综述系统梳理抑郁症患者常见的躯体症状及其临床意义，现有证据显示在症状表现中，疼痛(如头痛、肌肉骨骼痛)较为常见，心肺症状(如心悸、胸闷)与胃肠道不适也极为突出，而多系统症状共存常提示病情更为严重；在临床影响方面，显著的躯体症状不仅会延迟抑郁症的识别与诊断，还与较差的抗抑郁治疗反应、更多的残留症状、更重的功能损害及更高的自杀风险密切相关。与此同时，越来越多的研究从炎症反应、单胺递质失衡及内感受加工异常等角度，为抑郁症躯体症状的发生与维持提供了神经生物学解释。本文通过整合现有证据，旨在强调躯体症状在抑郁症全程管理中的核心地位，为临床开展系统评估与综合干预提供理论依据，并指出未来研究需进一步关注症状特异性机制及个体化治疗策略。

Abstract: Depression, a prevalent mental disorder, frequently manifests with prominent somatic symptoms. Beyond core emotional disturbances, approximately one-third to half of patients present primarily with physical complaints, making their recognition and management a crucial challenge in clinical practice. This review systematically synthesizes evidence on the common somatic symptoms in depression and their clinical implications. Research indicates that pain (e.g., headache, musculoskeletal pain) is the most frequent somatic presentation. Cardiovascular symptoms (e.g., palpitations, chest tightness) and gastrointestinal discomfort are also highly prevalent. The coexistence of symptoms across multiple systems often signals greater illness severity. Regarding clinical impact, significant somatic symptoms are not only associated with delays in diagnosing depression but are also closely linked to poorer antidepressant treatment response, a higher burden of residual symptoms, more severe functional impairment, and an increased risk of suicide. Meanwhile, accumulating evidence from inflammatory processes, monoaminergic dysregulation, and alterations in interoceptive processing provides neurobiological explanations for the emergence and persistence of somatic symptoms in depression. By integrating current evidence, this article underscores the central role of somatic symptoms in the comprehensive management of depression. It provides a rationale for implementing systematic assessment and integrated interventions in clinical practice and highlights the need for future research to focus on symptom-specific mechanisms and the development of individualized treatment strategies.