On any day, about 5-10% of your patients are experiencing depression. During our lifetimes, up to 20% of us will find ourselves feeling blue for no real reason. You are probably already aware of the psychological symptoms of depression:• Ongoing sense of sadness• Lack of motivation or interest in things that were formerly enjoyed• Feeling helpless and hopeless• Tearfulness• Irritability and being intolerant of others• Short attention span• Difficulty making decisionsWhen patients report any of the above, you know to look closer for possible depression. But did you know there are also physical signs that can indicate a patient may be depressed? Here are six symptoms to watch for, especially when combined with one or two from the list above:1. Migraine headaches. There is a relationship between migraines and depression, even if someone already has a history of migraines. When a patient has an established pattern of migraines, depression can cause them to be more frequent or severe. For those with documented clinical depression, there is a three-fold risk of having a migraine.2. Gastro-intestinal issues. Depression can contribute to the onset of all types of GI woes: constipation, diarrhea, nausea, or an upset stomach. Studies have shown that depression or anxiety is present in 60% of patients with Irritable Bowel Syndrome (IBS). Depression should be ruled out before starting any aggressive treatment.3. Increased pain. The link between chronic pain and depression is undeniable and well documented. Also, the University of Alberta found that when people with no history of neck or back pain had depression, their chances of developing severe or disabling pain were multiplied by four. Depression and pain share common pathways in the brain, so they can directly influence each other.4. Sleep problems. About 15% of depressed people have hypersomnia; they sleep more than ten hours a night. At the other end of the spectrum, insomnia can be a problem in depression. Trouble falling asleep, staying asleep, or early morning wakefulness can make depression worse. Complaints of fatigue, even when getting adequate sleep, are also associated with depression.5. Chest pain. Certainly all chest pain should be immediately evaluated for possible cardiac emergencies or complications, including heart disease. But when a medical evaluation rules out any pathology or illness, consider depression, says University of Gothenburg in Sweden.6. Weight changes. While some people with depression report weight loss and lack of appetite, studies indicate that weight gain to be more common. There seems to be a correlation between obesity and depression, related to a chronic inflammation process also related to diabetes and heart disease. Depression is an illness that can respond well to treatment. But first it has to be diagnosed. When talking with your patients, listen to their complaints, both psychological and physical. Your interactions with them, along with observation and documentation, may be the first step in getting them the help they need.