Depressed
patients who suffer from pain take longer to
achieve remission than those who do
not
Comorbidity
of depression and pain is common, the symptoms
of each being mutually exacerbating. It has been
shown that the serotonin and noradrenaline
reuptake inhibitors have superior efficacy
compared to the selective serotonin reuptake
inhibitors on pain relief, especially
neuropathic pain syndromes. Recently it has been
suggested that in patients treated for
depression who also suffer from bodily pain
antidepressant response is more difficult to
achieve. A study has tested the hypothesis that
in patients with recurrent depression, the
presence of great pain at baseline would predict
a delayed time to remission following
treatment.
Subjects (n = 230) were aged between 21 and 65
years with highly recurrent unipolar depression
with a minimum score of 15 on the Hamilton
Rating (HAM-D) scale and 7 on the Raskin
severity of depression scale. Before treatment
with 150 to 300 mg of imipramine, self-reported
pain and somatic symptoms were assessed with the
Hopkins Symptom Checklist.
There was an association between higher pain and
somatic scores with longer time to remission.
After taking into account baseline severity of
depression, pain was the only factor remaining
significant in predicting a longer time to
remission. The median time to remission was 17
weeks (remission rate of 68%) for subjects in
the group reporting pain and 12.3 weeks
(remission rate of 79%) for patients not
reporting pain. Headache and muscle soreness
were the pain items associated with a slower
remission, whereas chest pain and low back pain
were not. Baseline pain and baseline somatic
scores were correlated with the HAM-D suicide
item score. Women reported more severe symptoms
both in pain and somatization.
Therefore, more reported pain, but not
somatization, at baseline predicted a more
delayed remission. Pain represent a signal of
difficult to treat depression and may be useful
in leading the clinician to adopt a more
aggressive treatment, such as dual mechanism
agents, and longer treatment to achieve
remission. Karp
JF, Scott J, Houck P, Reynolds CF 3rd, Kupfer
DJ, Frank E. Pain predicts longer time to
remission during treatment of recurrent
depression. J Clin Psychiatry
2005,66:591-597.