Pain Predicts Longer Time to Remission During Treatment of Recurrent Depression
J Clin Psychiatry 2005;66(5):591-597
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Introduction: Pain and depression are mutually
exacerbating. We know that both of these syndromes predict the
future occurrence of the other. It has not been shown, however,
whether the presence of pain slows the effect of treatment for
depression. We hypothesized that greater pain and somatic scores
prior to treatment with imipramine and interpersonal
psychotherapy would predict a slowed time to remission from
Method: We performed secondary data analyses of
an archived study. Subjects (N = 230) were between 21 and 65 years
of age and were enrolled in a study of maintenance treatment for
recurrent unipolar depression. Patients had to meet Research
Diagnostic Criteria (RDC) for a major depressive episode and
historical requirements for at least 3 prior episodes and clear
remissions (according to RDC). Patients were also required to
have a minimum Hamilton Rating Scale for Depression score of 15
and a minimum score of 7 on the Raskin Severity of Depression
Scale. This report describes the acute treatment phase, during
which all subjects received combination therapy consisting of
imipramine hydrochloride (150 to 300 mg) and interpersonal
psychotherapy. Pain and somatization were measured with the
Hopkins Symptom Checklist.
Results: Higher levels of both pain and
somatization predicted a longer time to remission. After
controlling for baseline severity of depression, only pain was
still significant in predicting a longer time to remission.
Headache and muscle soreness were the 2 variables from the pain
index whose presence independently predicted a slower remission.
Both pain and somatization improved during acute treatment.
Subjects with more pain and somatization, after controlling for
severity of depression, reported more suicidality. Women reported
more pain than men.
Conclusions: Pain, but not somatization,
predicted a longer time to remission and may be a marker of a
more difficult-to-treat depression. Adults with recurrent
depression should be screened for the presence of pain prior to
treatment, as the presence of these symptoms may require more
aggressive treatment or may be a marker for suicidality or the
use of dual-mechanism antidepressants.