SYMPOSIA
SYMPOSIA
SYMPOSIA
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[PS-15]<br />
Symposium Title: Depression and pain<br />
Impact of pain on treatment in depression<br />
Cengiz Akkaya<br />
Departments of Psychiatry, Uludag University, Bursa, Turkey<br />
E-mail: cakkaya@uludag.edu.tr<br />
Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org<br />
Abstracts of the Invited Speakers<br />
Major depressive disorder (MDD) is a chronic, disabling condition with a wide range of symptoms, including core mood symptoms of<br />
depression and anxiety, cognitive and behavioral deficits, and somatic/physical disturbances. Approximately two-thirds of patients with<br />
depression experience physical pain symptoms (e.g. headache, neck and back pain, abdominal pain, diffuse musculoskeletal pain). Pain<br />
as a symptom of depression, often has a negative impact upon other depressive symptoms (for example, it may induce or exacerbate<br />
low energy, sleep disturbance, and anxiety), adherence to medication, and obtaining adequate therapy. Therefore, pain influences both<br />
the course of depressive illness and the treatment outcome. Also the severity of pain is found to be a strong predictor of poor response<br />
and health-related quality of life. Impairments in social and occupational functioning may increase when depression and pain coexist.<br />
Patients who fail to achieve remission after antidepressant therapy are more likely to suffer residual pain and other physical symptoms<br />
compared with remitted patients.<br />
The close relationship between pain and depression, and the growing evidence of a connection between treatment outcomes in these<br />
conditions, suggests that maximal patient benefit may result from treatments which effectively address both emotional and physical<br />
symptom domains. Therefore, treatments that address both depression and pain are highly desirable. Neurobiological evidence suggests<br />
that mood and chronic pain are connected via serotonin and noradrenaline neurotransmitter pathways. Serotonin and norepinephrine<br />
play a key modulating role in pain mechanisms in the central nervous system. Serotonin modulates both descending inhibitory and<br />
facilitatory pathways and thus exerts both an antinociceptive and a pronociceptive effect. Noradrenaline, however, typically acts centrally<br />
in an antinociceptive manner, exerting its effects via a-2-adrenoreceptors in the descending antinociceptive pathways.<br />
Efficacy for treating pain is best established for tricyclic antidepressants. But through the last decade, antidepressant medications,<br />
particularly selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and norepinephrine reuptake inhibitors (SNRIs), are<br />
widely used in the management of MDD. SSRIs are often favored in practice because of their tolerability and safety. However, their efficacy<br />
in pain is thought to be relatively weak. On the other hand the mechanism of SNRIs has been hypothesized to confer analgesic effects<br />
independent of antidepressant action. Evidence suggests that potentiation of both serotonin and norepinephrine is required for effective<br />
analgesia; drugs that inhibit only one of these systems (particularly serotonin) appear to have a limited effect. Whether antidepressants<br />
relieve pain through direct analgesic effects or indirectly through antidepressant action is still under discussion. There may be a close<br />
association between analgesic and antidepressant effects and pain relief may be secondary to mood improvement.<br />
Key words: Pain, depression, antidepressant<br />
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S81<br />
Clinical characteristics and mechanism of pain in depression<br />
Selçuk Kırlı<br />
Department of Psychiatry, Uludag University, Bursa, Turkey<br />
E-mail: kselcuk@uludag.edu.tr<br />
Although there is a large amount of data indicating that depression and pain symptoms are closely interrelated, they are not included in<br />
depression symptoms in the classification systems. Even so, new developments in neuroscience have carried the data on this interrelation<br />
and co-occurrence beyond the epidemiological dimension to the awareness of a common underlying mechanism (1,2).<br />
Although such a co-occurrence and the mechanisms that influence it are being discussed more and more, pain symptoms still cannot<br />
be well assessed or monitored and they are usually described by terms such as ‘medically unexplainable’, ‘functional’ or ‘psychosomatic’.<br />
The following statements may be made about the clinical characteristics of the symptoms (1):<br />
• They do not conform to the anatomic localizations which would help explain their causes.<br />
• They may vary in severity and location.<br />
S81