[Depression and pain: novel clinical, neurobiological and psychopharmacological data].

Dec 20, 2005Psychiatria polska

New Clinical, Brain, and Drug Research on Depression and Pain

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Abstract

Frequent pain symptoms are reported in depressive patients, indicating a possible link between mood and pain perception.

There is a marked prevalence of depression in patients experiencing pain conditions.
Disturbances in serotonin and norepinephrine pathways, along with neuropeptides, may play significant roles in both depression and pain.
Key brain regions involved in mood regulation and pain perception include the amygdala, anterior cingulate cortex, and prefrontal cortex.
Dual action antidepressants that affect both serotonin and norepinephrine may offer a stronger antidepressant effect and broader therapeutic benefits.
These antidepressants are increasingly being used to treat pain symptoms in various somatic conditions, such as diabetic neuropathy and fibromyalgia.

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Epidemiological studies confirm frequent appearance of pain symptoms in depressive patients and a marked prevalence of depression in pain conditions. These observations seem to point at a close intertwining between mood regulation and pain perception. In the pathogenesis of both depression and pain symptoms, an important role has been attributed to disturbances of serotonergic and noradrenergic neurotransmission as well as to neuropeptides such as opioids and substance P. In mood regulation as well as in the perception and emotional dimension of pain stimuli, such brain structures as the amygdala, anterior cingulate cortex and prefrontal cortex are of main significance. The action of antidepressant drugs results in a normalization of the activity of those neurotransmitter systems and brain structures. It was found that dual action antidepressants (i.e. influencing both serotonergic and noradrenergic system) such as tricyclic antidepressants and new generation drugs (venlafaxine, milnacipram, duloxetine, mirtazapine) exert a stronger antidepressant effect and possess a broader therapeutic spectrum, including also an effect on pain symptoms. These drugs have been also increasingly used for the treatment of pain symptoms in somatic illnesses (e.g. diabetic neuropathy, fibromyalgia).

[Depression and pain: novel clinical, neurobiological and psychopharmacological data].

Abstract

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