Psychiatria pre prax 2/2007

Depression and pain comorbidity

The presence and intensity of a chronic painful physical condition influences strongly the frequency and severity of depressive symptoms in patients with major depression. The pain is found in nearly half of subject with major depressive disorder. Painful symptoms predict more severe form of depression, a longer time to remission, and may be a marker of resistency to treatment. The emotional and painful physical symptoms of depression are particularly regulated by serotonergic and noradrenergic pathways in the brain and spinal cord. Data from controlled clinical trials support the suggestion that medication with dual action appears to be the most robust in both antidepressive and analgetic efficacy.

Keywords: depression, pain, epidemiology, pathophysiology, dual antidepressants, venlafaxine, duloxetine.