Somatized depression as a subgroup of fibromyalgia syndrome.

An increase of depressive symptoms in fibromyalgia patients has been noted in a number of studies. The etiologic significance of this finding remains, however, controversial. We suggest that a subgroup of patients with this symptom combination may be pragmatically classified as suffering from somatized depression. Clinical indicators such as a family history of depressive disorders, circadian disturbances, pronounced loss of appetite or libido, and chronic psychosocial stressors should be assessed and, if present, prompt the initiation of psychiatric evaluation and treatment including pharmaco- and psychotherapeutic modalities. Other psychiatric diseases arising in the differential diagnosis of fibromyalgia are discussed.