Management of depression in the presence of pain symptoms

Psychiatr Danub. 2010 Mar;22(1):4-13.

Abstract

Somatic illness is frequently associated with depression and anxiety and major depression significantly increases risk of severe medical conditions, e.g. cardiovascular illness. One of the most frequent comorbidities is that of depression and pain. Alterations in noradrenergic and serotonergic neurotransmissions in the central nervous system have been implicated in the joint pathophysiology of depression and chronic pain. Antidepressants, alone or in combination with psychotherapy, are an effective treatment option in such cases. The newer dual action antidepressants (milnacipran, venlafaxine, duloxetine) acting specifically on both noradrenergic and serotonergic neurotransmitter systems are presumably more reliable in pain management. So far, the most extensively studied drug has been duloxetine. Twelve randomized placebo-controlled trials with the total number of 4,108 patients suffering from pain associated with major depressive disorder suggested consistent analgesic efficacy of duloxetine, especially in fibromyalgia and peripheral neuropathic pain.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / therapeutic use*
  • Brain / drug effects
  • Brain / physiopathology
  • Chronic Disease
  • Clinical Trials as Topic
  • Combined Modality Therapy
  • Comorbidity
  • Cyclohexanols / adverse effects
  • Cyclohexanols / therapeutic use*
  • Cyclopropanes / adverse effects
  • Cyclopropanes / therapeutic use*
  • Depressive Disorder, Major / drug therapy*
  • Depressive Disorder, Major / physiopathology
  • Depressive Disorder, Major / psychology
  • Drug Therapy, Combination
  • Duloxetine Hydrochloride
  • Fibromyalgia / drug therapy
  • Fibromyalgia / physiopathology
  • Fibromyalgia / psychology
  • Humans
  • Milnacipran
  • Mind-Body Relations, Metaphysical / drug effects
  • Mind-Body Relations, Metaphysical / physiology
  • Norepinephrine / metabolism
  • Pain / drug therapy*
  • Pain / physiopathology
  • Pain / psychology
  • Psychotherapy
  • Serotonin / metabolism
  • Thiophenes / adverse effects
  • Thiophenes / therapeutic use*
  • Treatment Outcome
  • Venlafaxine Hydrochloride

Substances

  • Antidepressive Agents
  • Cyclohexanols
  • Cyclopropanes
  • Thiophenes
  • Serotonin
  • Venlafaxine Hydrochloride
  • Duloxetine Hydrochloride
  • Milnacipran
  • Norepinephrine