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This catecholamine surge increases alertness, suppresses appetite through stimulation of the hypothalamus, and elevates heart rate and blood pressure as secondary effects

Matrix metalloproteinases (MMPs) are up-regulated by pro-inflammatory cytokines, as well as by acute phase proteins like serum amyloid A (SAA), with counter-regulatory inhibition by IL-4 and IL-13, and released into the circulation from damaged vascular endothelium

Lancet 392(10157):15191529

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consequently, utilizing the total scores would produce equivocal findings about affective symptoms due to the influence of somatic symptoms on the total scores