Phpsy/2011-07-0066/7.11.2011/Macmillan Original Paper Hegerl U et al. Does Pain Improve Earlier … Pharmacopsychiatry received 22.07.2011 revised 02.09.2011 accepted 27.09.2011 Bibliography DOI http://dx.doi.org/ 10.1055/s-0031-1291295 Published online ahead of print Pharmacopsychiatry © Georg Thieme Verlag KG Stuttgart · New York ISSN 0176-3679 Correspondence U. Hegerl Department of Psychiatry University of Leipzig Semmelweisstraße 10 04103 Leipzig Germany Tel.: +49/0341/972 4530 Fax: +49/0341/972 4539 Ulrich.Hegerl@medizin. uni-leipzig.de Key words ● ▶ antidepressants ● ▶ depression ● ▶ pain syndromes Does Pain Improve Earlier than Mood in Depressed Patients with Painful Physical Symptoms Treated with Duloxetine? symptoms has been shown for tricyclic antide- pressants and serotonin noradrenaline reuptake inhibitors [6–9]. In a naturalistic study with antidepressants for long-term treatment of painful physical symp- toms and emotional symptoms of depression [10], the effects of selective serotonin reuptake inhibitors (SSRIs) on painful physical symptoms were found to be less pronounced than those on the emotional depressive symptoms. The assumption of an analgesic effect of tricyclic antidepressants and serotonin noradrenaline reuptake inhibitors, independent of their antide- pressant effect, is supported by their analgesic effects in non-depressed patients [11–18]. A chart review revealed that antidepressant treat- ment at both low and therapeutic doses goes along with similar response rates in chronic pain and similar pain response rates were detected for tri- cyclic antidepressants, selective serotonin reup- take inhibitors/selective noradrenaline reuptake inhibitors and atypical antidepressants [19]. A recent post-hoc analysis of 6 randomized pla- cebo-controlled trials in patients with major depression examined whether antidepressant Introduction ▼ About 15 % of women and 7 % of men suffer from depression at some point in their lives [1]. Two- thirds of these patients suffer from somatic symptoms like pain [2]. These patients are char- acterized by considerable disability [3], and pain represents a predictor for longer time to remis- sion during treatment of recurrent depression [4]. This remarkable association of depression and painful somatic complaints may be explained by different mechanisms: (i) pain syndromes trigger depression; (ii) depression causes pain syndromes (e. g., via elevated muscle tone); (iii) patients feel already existing painful somatic symptoms as less tolerable and less bearable and interpret them more negatively in the context of depres- sive disorders. So far, the interaction of depression and pain is not fully understood [5]. Generally, successful treatment of depression with antidepressants goes along with improve- ment of painful physical symptoms. Improve- ment of depressive as well as painful physical Authors U. Hegerl 1 , R. Mergl 1 , D. Quail 2 , E. Schneider 3 , H.-P. Hundemer 3 , M. Linden 4 Affiliations 1 Department of Psychiatry , University of Leipzig, Leipzig, Germany 2 Lilly UK, Department European Medical Information Sciences, Windlesham, Surrey , United Kingdom 3 Lilly Germany , Medical Department, Division of Neuroscience, Bad Homburg, Germany 4 Research Group Psychosomatic Rehabilitation at the Charité , University Medicine Berlin and the Rehabilitation Centre Seehof, Teltow/Berlin, Germany Abstract ▼ Introduction: In depressed patients tricyclic antidepressants and selective serotonin and noradrenaline reuptake inhibitors can reduce not only depressive, but also painful physical symp- toms. We investigated whether under treatment with duloxetine pain improves earlier than mood. Methods: Data were obtained within a prospec- tive 6-month multi-centre naturalistic study in adult out-patients with depressive episodes treated with duloxetine ( flexible doses: 30–120 mg/day). Pain and mood were assessed daily by visual ana- logue scales. For responders (n = 622) “time to 50 % pain response” and “time to 50 % mood response” were determined by counting the earliest day between day 0 and 27, at which the patient achieved 50 % improvement. Results: Mean time to 50 % pain response (mean 6.3 days, SD 5.3) was significantly shorter than time to 50 % mood response (mean 7.6 days, SD 6.0, mean difference 1.3 days, SD 6.4; p < 0.0001). Discussion: In duloxetine-responders to both pain and mood, self-rated pain improved slightly earlier than self-rated mood. The short temporal dissociation between pain and mood improve- ment might be explained by an earlier conscious perception of pain than mood changes. Downloaded by: Universität Leipzig. Copyrighted material.