SYMPOSIA

Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Abstracts of the Invited Speakers
The differences between SSRIs and SNRIs in the treatment of psychiatric pain syndromes
Abdurrahman Altındağ, Gülçin Elboğa
Gaziantep University, Medical School, Department of Psychiatry, Gaziantep, Turkey
E-mail: draltindag@yahoo.com, aaltindag@yahoo.com
The occurrence of depression with physical symptoms and pain is common. On the other hand, comorbid depression is also common
in chronic pain syndromes. Antidepressants are effective in the treatment of psychological and physical symptoms of depression and
chronic pain symptoms of non-depressed patients.
It is not well described how antidepressants relieve the pain. However, it is suggested that this effect is related to serotonin and
noradrenaline. Analgesic effects of antidepressants are independent from their effects on the mood. Antidepressants which have effects
on both serotonin and noradrenaline are more effective than those with effects on one of these neurotransmitters in the treatment of
depression and comorbid pain syndromes. Tricylic antidepressants (TCAs) have serotoninergic and noradrenergic effects. Therefore, they
are superior to monoaminergic antidepressants, such as SSRIs, with regard to analgesic and antidepressant effects. The usage of TCAs is
limited because of their safety profile and side effects. SNRIs have similar analgesic effects to TCAs. On the other hand they have lower
side effects and a better safety profile. Additionally, SNRIs are more effective than SSRIs in the treatment of physical pain syndromes. SNRIs
have a similar safety profile to SSRIs and almost similar costs to the older agents.
Better diagnosis and treatment of pain symptoms, which are strong indicator of depressive relapses, will provide better quality of life and
productivity in patients with depressive disorders.
Key words: SSRI, SNRI, pain
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S55
How does alexithymia lead to painful syndromes?
Hüseyin Güleç
Erenkoy Psychiatry Hospital, Istanbul, Turkey
E-mail: huseyingulec@yahoo.com
Several studies have focussed on defining the network of brain structures involved in pain. Pain perception (sensory discriminative,
affective/emotional, cognitive/evaluative) has been shown to depend on different areas of the brain. Modern neuroimaging methods
have been used to determine whether different pain symptoms involve similar brain structures. These studies indicated that acute
physiological pain and neuropathic pain have distinct although overlapping brain activation patterns, but that there is no unique pain
matrix/allodynia network.
Several contemporary neuroscientists and cognitive scientists make a similar distinction between emotions as bodily events and feelings
as mental events and regard symbolization as an important element in the cognitive processing of emotions. Awareness of feelings,
together with the thoughts, fantasies, and memories that they elicit, facilitates modulation of the emotional arousal induced by stressful
events. Feelings are attributed to the symbolic representation in working memory of the activity of unconsciously operating subsymbolic
systems that generate the brain states and bodily responses which comprise emotions. These representations become integrated with
representations of past experiences and representations of the self. Attributing the feeling of specific basic emotions to ‘viscerosomatic
self-representations’ in the lower levels of the brain, attributing reflective awareness and the capacity for experiencing higher-order
feelings to linguistic symbolizations and an ability to think in perceptual images is important for the parsing and regulation of emotional
states.
According to Lumley alexithymia is associated with tonic physiological hyperarousal, certain types of unhealthy behavior, and a biased
perception and reporting of somatic sensations and symptoms. Alexithymia probably influences illness behavior, but there is little
support for the hypothesis that alexithymia leads to chronic organic disease. Alexithymia links with physical illness due to four possible
pathways: a) alexithymia leads to organic disease through physiological or behavioral mechanisms, b) alexithymia leads to illness behavior
through cognitive or social mechanisms, c) physical illness leads to alexithymia, and d) both alexithymia and physical illness result from
sociocultural or biological factors. Research on the effects of emotional trauma resulted in the hypothesis that traumatic experiences in
childhood or adult life may have adverse consequences for physical health. It has been shown that there is evidence of a correlational
association between childhood trauma and somatization in adulthood, and several retrospective studies with very large samples have
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