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Yun Y, Zhang Q, Zhao W, Ma T, Fan H, Bai L, Ma B, Qi S, Wang Z, An H, Yang F. Relationship between the tryptophan-kynurenine pathway and painful physical symptoms in patients with major depressive disorder. J Psychosom Res 2022; 163:111069. [PMID: 36335711 DOI: 10.1016/j.jpsychores.2022.111069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate the relationship between the tryptophan-kynurenine (TRP-KYN) pathway and painful physical symptoms (PPS) in major depressive disorder (MDD). METHODS Eighty-four patients with MDD (40 patients with PPS and 44 without PPS) and forty-six healthy controls (HC) were recruited. The serum levels of tryptophan (TRP), kynurenine(KYN), kynurenic acid (KA), quinolinic acid (QA), 3-hydroxy-kynurenine (3-HK), serotonin (5-HT) were measured using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Depression, anxiety and pain were assessed using Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and Short-form McGill pain questionnaire (SFMPQ) respectively. RESULTS Patients in the MDD group exhibited significantly lower KA and 5-HT levels than HC, whereas MDD patients with PPS showed higher KYN and QA levels, and a higher KYN/TRP ratio than those without. There was a positive correlation between the scores of SFMPQ and QA levels and a negative correlation between the scores of SFMPQ and TRP levels or KA/QA ratios in MDD patients with PPS group. Stepwise multiple regression analysis showed that the KYN/TRP ratios, the KA/QA ratios, and the HAMD scores were significant predictor factors for SFMPQ scores. CONCLUSIONS These results demonstrated that the TRP-KYN pathway may play a role in the pathophysiology of pain in patients with major depressive disorder, suggesting that further studies of this pathway as a potential biomarker or therapeutic target are required.
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Affiliation(s)
- Yajun Yun
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Qi Zhang
- Wuxi Mental Health Center, Wuxi, China
| | - Wenxuan Zhao
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Ting Ma
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Hongzhen Fan
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Luyuan Bai
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Botao Ma
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Siyuan Qi
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Zhiren Wang
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Huimei An
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China.
| | - Fude Yang
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China.
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Yan R, Geng JT, Huang YH, Zou HW, Wang XM, Xia Y, Zhao S, Chen ZL, Zhou H, Chen Y, Yao ZJ, Shi JB, Lu Q. Aberrant functional connectivity in insular subregions in somatic depression: a resting-state fMRI study. BMC Psychiatry 2022; 22:146. [PMID: 35209866 PMCID: PMC8867834 DOI: 10.1186/s12888-022-03795-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Somatic depression (SD) is different from non-somatic depression (NSD), and insular subregions have been associated with somatic symptoms. However, the pattern of damage in the insular subregions in SD remains unclear. The aim of this study was to use functional connectivity (FC) analyses to explore the bilateral ventral anterior insula (vAI), bilateral dorsal anterior insula (dAI), and bilateral posterior insula (PI) brain circuits in SD patients. METHODS The study included 28 SD patients, 30 NSD patients, and 30 matched healthy control (HC) subjects. All participants underwent 3.0 T resting state functional magnetic resonance imaging. FC analyses were used to explore synchronization between insular subregions and the whole brain in the context of depression with somatic symptoms. Pearson correlation analyses were performed to assess relationships between FC values in brain regions showing significant differences and the total and factor scores on the 17-item Hamilton Rating Scale for Depression (HAMD17). RESULTS Compared with the NSD group, the SD group showed significantly decreased FC between the left vAI and the right rectus gyrus, right fusiform gyrus, and right angular gyrus; between the right vAI and the right middle cingulate cortex, right precuneus, and right superior frontal gyrus; between the left dAI and the left fusiform gyrus; and between the right dAI and the left postcentral gyrus. Relative to the NSD group, the SD group exhibited increased FC between the left dAI and the left fusiform gyrus. There were no differences in FC between bilateral PI and any brain regions among the SD, NSD, and HC groups. Within the SD group, FC values between the left vAI and right rectus gyrus were positively correlated with cognitive impairment scores on the HAMD17; FC values between the right vAI and right superior frontal gyrus were positively related to the total scores and cognitive impairment scores on the HAMD17 (p < 0.05, uncorrected). CONCLUSIONS Aberrant FC between the anterior insula and the frontal and limbic cortices may be one possible mechanism underlying SD.
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Affiliation(s)
- Rui Yan
- grid.41156.370000 0001 2314 964XNanjing Brain Hospital, Medical School, Nanjing University, 22 Hankou Road, Nanjing, 210093 China ,grid.89957.3a0000 0000 9255 8984Department of psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029 China
| | - Ji Ting Geng
- grid.89957.3a0000 0000 9255 8984Department of psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029 China ,grid.13402.340000 0004 1759 700XAffiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Hong Huang
- grid.41156.370000 0001 2314 964XNanjing Brain Hospital, Medical School, Nanjing University, 22 Hankou Road, Nanjing, 210093 China ,grid.89957.3a0000 0000 9255 8984Department of psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029 China
| | - Hao Wen Zou
- grid.41156.370000 0001 2314 964XNanjing Brain Hospital, Medical School, Nanjing University, 22 Hankou Road, Nanjing, 210093 China ,grid.89957.3a0000 0000 9255 8984Department of psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029 China
| | - Xu Miao Wang
- grid.89957.3a0000 0000 9255 8984Department of psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029 China
| | - Yi Xia
- grid.89957.3a0000 0000 9255 8984Department of psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029 China
| | - Shuai Zhao
- grid.89957.3a0000 0000 9255 8984Department of psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029 China
| | - Zhi Lu Chen
- grid.89957.3a0000 0000 9255 8984Department of psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029 China
| | - Hongliang Zhou
- grid.89957.3a0000 0000 9255 8984Department of psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029 China
| | - Yu Chen
- grid.89957.3a0000 0000 9255 8984Department of psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029 China
| | - Zhi Jian Yao
- Nanjing Brain Hospital, Medical School, Nanjing University, 22 Hankou Road, Nanjing, 210093, China. .,Department of psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, China. .,School of Biological Sciences and Medical Engineering, Southeast University, No. 2 sipailou, Nanjing, 210096, China.
| | - Jia Bo Shi
- Department of psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210029, China.
| | - Qing Lu
- School of Biological Sciences and Medical Engineering, Southeast University, No. 2 sipailou, Nanjing, 210096, China. .,Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, 210096, China.
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Oluboka OJ, Katzman MA, Habert J, Khullar A, Oakander MA, McIntosh D, McIntyre RS, Soares CN, Lam RW, Klassen LJ, Tanguay R. Early Optimized Pharmacological Treatment in Patients With Depression and Chronic Pain. CNS Spectr 2022; 28:1-40. [PMID: 35195060 DOI: 10.1017/s1092852922000128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractMajor depressive disorder (MDD) is the leading cause of disability worldwide. Patients with MDD have high rates of comorbidity with mental and physical conditions, one of which is chronic pain. Chronic pain conditions themselves are also associated with significant disability, and the large number of patients with MDD who have chronic pain drives high levels of disability and compounds healthcare burden. The management of depression in patients who also have chronic pain can be particularly challenging due to underlying mechanisms that are common to both conditions, and because many patients with these conditions are already taking multiple medications. For these reasons, healthcare providers may be reluctant to treat such patients. The Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines provide evidence-based recommendations for the management of MDD and comorbid psychiatric and medical conditions such as anxiety, substance use disorder, and cardiovascular disease; however, comorbid chronic pain is not addressed. In this article, we provide an overview of the pathophysiological and clinical overlap between depression and chronic pain and review evidence-based pharmacological recommendations in current treatment guidelines for MDD and for chronic pain. Based on clinical experience with MDD patients with comorbid pain, we recommend rapidly and aggressively treating depression according to CANMAT treatment guidelines, using antidepressant medications with analgesic properties, while addressing pain with first-line pharmacotherapy as treatment for depression is optimized. We review options for treating pain symptoms that remain after response to antidepressant treatment is achieved.
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Ng SM, Yin MXC, Chan JSM, Chan CHY, Fong TCT, Li A, So KF, Yuen LP, Chen JP, Chung KF, Chan CLW. Impact of mind-body intervention on proinflammatory cytokines interleukin 6 and 1β: A three-arm randomized controlled trial for persons with sleep disturbance and depression. Brain Behav Immun 2022; 99:166-176. [PMID: 34634445 DOI: 10.1016/j.bbi.2021.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/08/2021] [Accepted: 09/27/2021] [Indexed: 01/14/2023] Open
Abstract
Depressed people are prone to sleep disturbance, which may in return perpetuate the depression. Both depression and sleep disturbance influence proinflammatory cytokines interleukin (IL) 6 and 1β. Thus interventions for depression should consider the effect on sleep disturbance, and vice versa. Integrative Body-Mind-Spirit (IBMS) and Qigong interventions have been applied in a wide range of health and mental health conditions, including depression and sleep disturbance. This study aimed to evaluate the effect of these two mind-body therapies for persons with both depressive symptoms and sleep disturbance. A three-arm randomized controlled trial was conducted among 281 participants, who were randomly assigned to either IBMS, Qigong or wait list control group. Participants in IBMS and Qigong groups received eight weekly sessions of intervention. Outcome measures were plasma concentrations of IL-6 and IL-1β, and a questionnaire containing Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies Depression Scale, Somatic Symptom Inventory, Perceived Stress Scale and Body-Mind-Spirit Holistic Well-being Scale. Outcomes were assessed at baseline (T0), immediate post-intervention (T1) and at three-months post-intervention (T2). Besides intervention efficacy analysis, path analysis was performed to explore the relations among perceived stress, depression, sleep disturbance, and IL-6 and IL-1β values. The study found both IBMS and Qigong reduced depression, sleep disturbance, painful and painless somatic symptoms, IL-6 and IL-1β levels, and increased holistic well-being. The effect sizes of IBMS and Qigong, mostly in the medium magnitude range, were approximatively equivalent. Path analysis models revealed a predictive role of perceived stress in depression and sleep disturbance, a bidirectional relationship between depression and sleep disturbance, and significant influence of depression and sleep disturbance on IL-6 and IL-1β. Compared with control, the findings support the efficacy of IBMS and Qigong interventions in relieving depression and sleep disturbance, and in reducing IL-6 and IL-1β levels.
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Affiliation(s)
- Siu-Man Ng
- Departments of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region; Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Margaret X C Yin
- Departments of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region; Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Jessie S M Chan
- Departments of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region; Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Celia H Y Chan
- Departments of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region; Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Ted C T Fong
- Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Ang Li
- Guangdong-Hong Kong-Macau Institute of CNS Regeneration, Guangdong Key Laboratory of Brain Function and Diseases, Jinan University, Guangzhou 510632, China; Departments of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; State Key Laboratory of Brain and Cognitive Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Kwok-Fai So
- Guangdong-Hong Kong-Macau Institute of CNS Regeneration, Guangdong Key Laboratory of Brain Function and Diseases, Jinan University, Guangzhou 510632, China; Departments of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region; State Key Laboratory of Brain and Cognitive Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Lai-Ping Yuen
- International Association for Health and Yangsheng, Hong Kong Special Administrative Region
| | - Jian-Ping Chen
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Ka-Fai Chung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Cecilia L W Chan
- Departments of Social Work and Social Administration, The University of Hong Kong, Hong Kong Special Administrative Region; Centre on Behavioral Health, Faculty of Social Sciences, The University of Hong Kong, Hong Kong Special Administrative Region
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Hou Q, Wang C, Hou C, Tan J, He S, Tang L, Yong N, Ding X, Jiang G, Liu J, Wang X. Individual differences in pain sensitivity in drug-naive patients with major depressive disorder: an fMRI study. Brain Imaging Behav 2021; 15:1335-1343. [PMID: 32712795 DOI: 10.1007/s11682-020-00332-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients with major depressive disorder (MDD) often report pain; however, the pain-related brain mechanism that contributes to MDD with pain remains largely unclear. In the current study, we aimed to observe the cortical responses by employing fMRI technique combined with thermal stimulation paradigm in 17 major depressive disorder patients with pain (MDDP), 19 major depressive disorder patients without pain (MDDNP), and 25 age- and gender-matched healthy control (HC) subjects. Participants completed the Hamilton Depression Rating Scale-17 (HAMD-17) and provided pain intensity ratings in response to noxious heat (51 °C) during task-fMRI scanning by visual analogue scale (VAS). In our results, there was no difference in pain intensity ratings during tonic heat stimulation between the HC group and MDDNP group (p > 0.05), while the MDDNP group had significantly higher HAMD scores compared with the HC group (p < 0.001). The MDDNP group had decreased brain activation in the postcentral gyrus (PCG) compared with the HC group, implying abnormal activation of the PCG may associate with the characterized depressive mood of painless MDD (p < 0.05). Additionally, there was no difference in HAMD scores between the MDDP group and MDDNP group (p > 0.05), while the MDDP group had significantly greater pain during tonic heat stimulation compared with the MDDNP group (p < 0.01). The MDDP group showed enhanced activation in the PCG compared with the MDDNP group (p < 0.05), which may relate to the abnormal regulation of pain in painful MDD. Our results suggested that higher PCG activation may play an important role in facilitating the occurrence of pain in depression.
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Affiliation(s)
- Qianmei Hou
- Neurology Department, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, 637000, People's Republic of China
| | - Chen Wang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710071, People's Republic of China
| | - Changyue Hou
- Neurology Department, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, 637000, People's Republic of China
| | - Juan Tan
- Neurology Department, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, 637000, People's Republic of China
| | - Shaoyue He
- Neurology Department, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, 637000, People's Republic of China
| | - Lei Tang
- Psychiatry Department, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, 637000, People's Republic of China
| | - Na Yong
- Psychiatry Department, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, 637000, People's Republic of China
| | - Xianghong Ding
- Psychiatry Department, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, 637000, People's Republic of China
| | - Guohui Jiang
- Neurology Department, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, 637000, People's Republic of China
- Research Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, People's Republic of China
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710071, People's Republic of China.
| | - Xiaoming Wang
- Neurology Department, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, 637000, People's Republic of China.
- Research Institute of Neurological Diseases, North Sichuan Medical College, Nanchong, 637000, People's Republic of China.
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6
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Dunlop BW, Still S, LoParo D, Aponte-Rivera V, Johnson BN, Schneider RL, Nemeroff CB, Mayberg HS, Craighead WE. Somatic symptoms in treatment-naïve Hispanic and non-Hispanic patients with major depression. Depress Anxiety 2020; 37:156-165. [PMID: 31830355 DOI: 10.1002/da.22984] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/29/2019] [Accepted: 11/28/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Somatic complaints are a major driver of health care costs among patients with major depressive disorder (MDD). Some epidemiologic and clinical data suggest that Hispanic and non-Hispanic Black patients with MDD endorse higher levels of somatic symptoms than non-Hispanic White patients. METHODS Somatic symptoms in 102 Hispanic, 61 non-Hispanic Black, and 156 non-Hispanic White patients with treatment-naïve MDD were evaluated using the somatic symptom subscale of the Hamilton anxiety rating scale (HAM-A). The other seven items of the HAM-A comprise the psychic anxiety subscale, which was also evaluated across ethnicities. RESULTS Hispanic patients reported significantly greater levels of somatic symptoms than non-Hispanic patients, but levels of psychic anxiety symptoms did not differ by ethnicity. Levels of somatic symptoms did not significantly differ between Black and White non-Hispanic patients. Within the Hispanic sample, somatic symptom levels were higher only among those who were evaluated in Spanish; Hispanics who spoke English showed no significant differences versus non-Hispanics. CONCLUSIONS In this medically healthy sample of patients with MDD, monolingual Spanish-speaking Hispanic patients endorsed high levels of somatic symptoms. Clinicians should be mindful that the depressive experience may manifest somatically and be judicious in determining when additional medical work-up is warranted for somatic complaints.
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Affiliation(s)
- Boadie W Dunlop
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah Still
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Devon LoParo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Vivianne Aponte-Rivera
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin N Johnson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Rebecca L Schneider
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Helen S Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - W Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
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7
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Oon-Arom A, Likhitsathian S, Maneeton B, Sulaiman AH, Shih-Yen EC, Udomratn P, Chen CH, Srisurapanont M. Subjective depressive symptoms associated with pain in patients with major depressive disorder: Findings from the study on the aspect of Asian depression. Perspect Psychiatr Care 2020; 56:188-193. [PMID: 31148197 DOI: 10.1111/ppc.12403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/04/2019] [Accepted: 05/14/2019] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To examine subjective depressive symptoms associated with physical pain symptoms (PPSs) in Asian patients with major depressive disorder (MDD). DESIGN AND METHODS Four PPSs, including headache, chest pain, low back pain, and muscle pain, and subjective depressive symptoms were assessed using the Symptom Checklist-90-Revised. FINDINGS Out of 528 participants, 390 (73.9%) had at least one PPS. After adjusting for sex, depression severity, disability, fatigue, physical health status, and mental health status, PPSs were found to be associated with crying easily, blaming oneself, feeling lonely, feeling blue, and worrying too much. PRACTICAL IMPLICATIONS Almost three-quarters of Asian patients with MDD experience PPSs. PPSs are associated with some subjective feelings of depression.
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Affiliation(s)
- Awirut Oon-Arom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Edwin Chan Shih-Yen
- Singapore Clinical Research Institute, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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8
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Landa A, Fallon BA, Wang Z, Duan Y, Liu F, Wager TD, Ochsner K, Peterson BS. When it hurts even more: The neural dynamics of pain and interpersonal emotions. J Psychosom Res 2020; 128:109881. [PMID: 31835079 PMCID: PMC7055518 DOI: 10.1016/j.jpsychores.2019.109881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 11/11/2019] [Accepted: 11/17/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Chronic pain is highly prevalent among patients with mood, anxiety, personality, and somatic symptom disorders; and patients with chronic pain often suffer from persistent interpersonal distress. However, the neural mechanisms underlying this phenomenon and its possible role in the etiology of chronic pain are not yet understood. Based on our Developmental Theory of Centralized/Somatoform Pain, and prior research suggesting the existence of a shared neural system subserving interpersonal emotions and pain, we aimed to identify the neural basis for modulation of pain by feelings of interpersonal rejection and the role of the early interpersonal environment in development of this shared neural system. METHODS During fMRI scanning, 22 healthy participants received moderately painful thermal stimuli in 3 interpersonal contexts: Acceptance, Rejection, and Reacceptance (modified Cyberball paradigm). Early interpersonal environment was assessed using the Parental Bonding Instrument. RESULTS Interpersonal context modulated activity in pain neural systems during rejection and during accepting interactions with previously rejecting others. Moreover, the subjective perception of rejection, even when rejection was not occurring, correlated positively with reported pain severity and neural activity in the insula. The magnitude of neural modulation in pain circuits by feelings of rejection was associated with the quality of early interpersonal experience with caregivers. CONCLUSIONS Results suggest that interpersonal emotions play an important role in the development and functioning of the pain system, supporting our Developmental Theory of predisposition to chronic centralized pain. These findings have direct implications for clinical practice, including the importance of treating interpersonal distress to alleviate pain.
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Affiliation(s)
- Alla Landa
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States of America; New York State Psychiatric Institute, New York, NY, United States of America.
| | - Brian A Fallon
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States of America; New York State Psychiatric Institute, New York, NY, United States of America
| | - Zhishun Wang
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States of America; New York State Psychiatric Institute, New York, NY, United States of America
| | - Yunsuo Duan
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States of America; New York State Psychiatric Institute, New York, NY, United States of America
| | - Feng Liu
- Department of Psychiatry, Columbia University Medical Center, New York, NY, United States of America; New York State Psychiatric Institute, New York, NY, United States of America
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States of America
| | - Kevin Ochsner
- Department of Psychology, Columbia University, New York, NY, United States of America
| | - Bradley S Peterson
- Institute for the Developing Mind, Children's Hospital Los Angeles, Division of Child & Adolescent Psychiatry, Keck School of Medicine at USC, CA, United States of America
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9
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Zhao D, Wu Z, Zhang H, Mellor D, Ding L, Wu H, Wu C, Huang J, Hong W, Peng D, Fang Y. Somatic symptoms vary in major depressive disorder in China. Compr Psychiatry 2018; 87:32-37. [PMID: 30195098 DOI: 10.1016/j.comppsych.2018.08.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/30/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE This study aimed to investigate the clinical characteristics of somatic symptoms of patients in China who suffer from major depressive disorder (MDD). METHOD 3273 patients who met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) MDD were recruited from 16 general hospitals and 16 mental health centers in China. Physicians and patients completed complementary customized depression disorder symptomatology questionnaires assessing the clinical characteristics of patients with MDD. RESULT 1. In this study we analyzed physician-recorded data. The major somatic symptoms in patients with MDD in China were insomnia (64.6%), pre-verbal physical complaints (46.9%), weight loss (38.5%), low appetite (37.6%), circulatory system complaints (31.3%), headache (31.3%), hyposexuality (31.0%), gastrointestinal symptom complaints (29.6%), and respiratory system complaints (29.6%). 2. Compared with MDD patients who sought medical help from mental health centers, MDD patients who sought medical help from general hospitals were more likely to suffer from urinary system complaints, headache, sensory system complaints, trunk pain, and nervous system complaints. A lower prevalence rate of insomnia and hyposexuality was also observed among MDD patients who visited general hospitals (p < .05). 3. Patients aged from 40 to 54 had the highest probability of pre-verbal physical complaints, respiratory system complaints, trunk pain, hyposexuality, limb pain and other pain conditions, while patients over 55 years of age had the lowest prevalence respiratory system complaints, hyposexuality, and other pain conditions, and they also had the highest rate of low appetite and insomnia. 4. Female patients appeared to exhibit higher rates of pre-verbal physical complaints, low appetite, and insomnia than male patients, but had fewer urinary systems complaints than male patients (p < .05). CONCLUSION The major somatic symptoms in patients with MDD in China are insomnia, pre-verbal physical complaints, weight loss, low appetite, circulatory system complaints, headache, hyposexuality, gastrointestinal system complaints, and respiratory system complaints. These symptoms vary by the type of medical setting to which patients present, and well as by age, and gender.
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Affiliation(s)
- Dongmei Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China; Shanghai Changning Mental Health Center, No 229, Xiehe Road, Changning District, Shanghai 200042, PR China
| | - Zhiguo Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - Huifeng Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - David Mellor
- School of Psychology, Deakin University, Melbourne, Australia
| | - Lei Ding
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - Haiyan Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - Chuangxin Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - Jia Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - Wu Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China
| | - Daihui Peng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China.
| | - Yiru Fang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, No.600, South Wanping Road, Xuhui District, 200030 Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders, PR China; CAS Center for Excellence in Brain Science and Intelligence Technology, PR China.
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Bozkurt S, Aktekin L, Alkan BM, Ural FG, Sezer N, Akkuş S. Effect of Illness Perception on the Quality of Life in Ankylosing Spondylitis. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.409013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Hong J, Novick D, Moneta MV, El-Shafei A, Dueñas H, Haro JM. Functional Impairment and Painful Physical Symptoms in Patients with Major Depressive Disorder Treated with Antidepressants: Real-World Evidence from the Middle East. Clin Pract Epidemiol Ment Health 2017; 13:145-155. [PMID: 29238391 PMCID: PMC5712648 DOI: 10.2174/1745017901713010145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/09/2017] [Accepted: 08/24/2017] [Indexed: 11/22/2022]
Abstract
Background The Global Burden of Disease 2010 study reported the relative size of major depressive disorder (MDD) burden to be greater in the Middle East and North Africa than anywhere else. However, little research has been carried out to examine the comparative effectiveness of antidepressants in this region. Objective To assess and compare functioning levels in Middle Eastern patients with MDD treated with either duloxetine or a selective serotonin reuptake inhibitor (SSRI), and to examine the impacts of depression-related pain on functioning by the type of treatment. Method This post-hoc analysis, which focused on Middle Eastern patients, used data from a 6-month prospective observational study that included 1,549 MDD patients without sexual dysfunction. Levels of functional impairment and depression-related pain were assessed using the Sheehan Disability Scale (SDS) and the modified Somatic Symptom Inventory, respectively. A mixed model with repeated measures (MMRM) was employed. Results The mean age of the patients was 37.3 (SD=8.4) years, and 34.6% were female. Patient functioning was, on average, moderately impaired at baseline, but improved substantially during follow-up in both the duloxetine (n=152) and the SSRI (n=123) cohorts. The MMRM results showed a lower level of functional impairment at 24 weeks in the duloxetine cohort than in the SSRI cohort (p<0.001). Pain severity at baseline was positively associated with functional impairment during follow-up only in the SSRI cohort (p=0.003). Conclusion Duloxetine-treated MDD patients achieved better functioning than SSRI-treated patients. This treatment difference was partly driven by depression-related pain.
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Affiliation(s)
- Jihyung Hong
- Department of Healthcare Management, Gachon University, Seongnam, South Korea
| | - Diego Novick
- Eli Lilly and Company, Windlesham, Surrey, United Kingdom
| | - Maria Victoria Moneta
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
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Wongpakaran T, Wongpakaran N, Tanchakvaranont S, Bookkamana P, Pinyopornpanish M, Wannarit K, Satthapisit S, Nakawiro D, Hiranyatheb T, Thongpibul K. Depression and pain: testing of serial multiple mediators. Neuropsychiatr Dis Treat 2016; 12:1849-60. [PMID: 27524903 PMCID: PMC4966501 DOI: 10.2147/ndt.s110383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Despite the fact that pain is related to depression, few studies have been conducted to investigate the variables that mediate between the two conditions. In this study, the authors explored the following mediators: cognitive function, self-sacrificing interpersonal problems, and perception of stress, and the effects they had on pain symptoms among patients with depressive disorders. PARTICIPANTS AND METHODS An analysis was performed on the data of 346 participants with unipolar depressive disorders. The 17-item Hamilton Depression Rating Scale, Mini-Mental State Examination, the pain subscale of the health-related quality of life (SF-36), the self-sacrificing subscale of the Inventory of Interpersonal Problems, and the Perceived Stress Scale were used. Parallel multiple mediator and serial multiple mediator models were used. An alternative model regarding the effect of self-sacrificing on pain was also proposed. RESULTS Perceived stress, self-sacrificing interpersonal style, and cognitive function were found to significantly mediate the relationship between depression and pain, while controlling for demographic variables. The total effect of depression on pain was significant. This model, with an additional three mediators, accounted for 15% of the explained variance in pain compared to 9% without mediators. For the alternative model, after controlling for the mediators, a nonsignificant total direct effect level of self-sacrificing was found, suggesting that the effect of self-sacrificing on pain was based only on an indirect effect and that perceived stress was found to be the strongest mediator. CONCLUSION Serial mediation may help us to see how depression and pain are linked and what the fundamental mediators are in the chain. No significant, indirect effect of self-sacrificing on pain was observed, if perceived stress was not part of the depression and/or cognitive function mediational chain. The results shown here have implications for future research, both in terms of testing the model and in clinical application.
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Affiliation(s)
- Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Kingdom of Thailand
| | - Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Kingdom of Thailand
| | | | - Putipong Bookkamana
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Kingdom of Thailand
| | - Manee Pinyopornpanish
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Kingdom of Thailand
| | - Kamonporn Wannarit
- Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Kingdom of Thailand
| | - Sirina Satthapisit
- Department of Psychiatry, Khon Kaen Regional Hospital, Khon Kaen, Kingdom of Thailand
| | - Daochompu Nakawiro
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Kingdom of Thailand
| | - Thanita Hiranyatheb
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Kingdom of Thailand
| | - Kulvadee Thongpibul
- Department of Psychology, Faculty of Humanities, Chiang Mai University, Chiang Mai, Kingdom of Thailand
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Novick D, Montgomery W, Haro JM, Moneta MV, Zhu G, Yue L, Hong J, Dueñas H, Brugnoli R. Functioning in patients with major depression treated with duloxetine or a selective serotonin reuptake inhibitor in East Asia. Neuropsychiatr Dis Treat 2016; 12:383-92. [PMID: 26966361 PMCID: PMC4770062 DOI: 10.2147/ndt.s100675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To assess and compare the levels of functioning in patients with major depressive disorder treated with either duloxetine with a daily dose of ≤60 mg or a selective serotonin reuptake inhibitor (SSRI) as monotherapy for up to 6 months in a naturalistic setting in East Asia. In addition, this study examined the impact of painful physical symptoms (PPS) on the effects of these treatments. PATIENTS AND METHODS Data for this post hoc analysis were taken from a 6-month prospective observational study involving 1,549 patients with major depressive disorder without sexual dysfunction. The present analysis focused on a subgroup of patients from East Asia (n=587). Functioning was measured using the Sheehan Disability Scale (SDS). Depression severity was assessed using the 16-item Quick Inventory of Depressive Symptomatology-Self Report. PPS were rated using the modified Somatic Symptom Inventory. A mixed model with repeated measures was fitted to compare the levels of functioning between duloxetine-treated (n=227) and SSRI-treated (n=225) patients, adjusting for baseline patient characteristics. RESULTS The mean SDS total score was similar between the two treatment cohorts (15.46 [standard deviation =6.11] in the duloxetine cohort and 16.36 [standard deviation =6.53] in the SSRI cohort, P=0.077) at baseline. Both descriptive and regression analyses confirmed improvement in functioning in both groups during follow-up, but duloxetine-treated patients achieved better functioning. At 24 weeks, the estimated mean SDS total score was 4.48 (standard error =0.80) in the duloxetine cohort, which was statistically significantly lower (ie, better functioning) than that of 6.76 (standard error =0.77) in the SSRI cohort (P<0.001). This treatment difference was more apparent in the subgroup of patients with PPS at baseline. Similar patterns were also observed for SDS subscores (work, social life, and family life). CONCLUSION Depressed patients treated with duloxetine achieved better functioning compared to those treated with SSRIs. This treatment difference was mostly driven by patients with PPS at baseline.
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Affiliation(s)
| | | | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Maria Victoria Moneta
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Gang Zhu
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China
| | - Li Yue
- Lilly Suzhou Pharmaceutical Company, Ltd, Shanghai, People's Republic of China
| | - Jihyung Hong
- Department of Healthcare Management, Gachon University, Seongnam, South Korea
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Jaracz J, Gattner K, Jaracz K, Górna K. Unexplained Painful Physical Symptoms in Patients with Major Depressive Disorder: Prevalence, Pathophysiology and Management. CNS Drugs 2016; 30:293-304. [PMID: 27048351 PMCID: PMC4839032 DOI: 10.1007/s40263-016-0328-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with major depression often report pain. In this article, we review the current literature regarding the prevalence and consequences, as well as the pathophysiology, of unexplained painful physical symptoms (UPPS) in patients with major depressive disorder (MDD). UPPS are experienced by approximately two-thirds of depressed patients. The presence of UPPS makes a correct diagnosis of depression more difficult. Moreover, UPPS are a predictor of a poor response to treatment and a more chronic course of depression. Pain, in the course of depression, also has a negative impact on functioning and quality of life. Frequent comorbidity of depression and UPPS has inspired the formulation of an hypothesis regarding a shared neurobiological mechanism of both conditions. Evidence from neuroimaging studies has shown that frontal-limbic dysfunction in depression may explain abnormal pain processing, leading to the presence of UPPS. Increased levels of proinflamatory cytokines and substance P in patients with MDD may also clarify the pathophysiology of UPPS. Finally, dysfunction of the descending serotonergic and noradrenergic pathways that normally suppress ascending sensations has been proposed as a core mechanism of UPPS. Psychological factors such as catastrophizing also play a role in both depression and chronic pain. Therefore, pharmacological treatment and/or cognitive therapy are recommended in the treatment of depression with UPPS. Some data suggest that serotonin and noradrenaline reuptake inhibitors (SNRIs) are more effective than selective serotonin reuptake inhibitors (SSRIs) in the alleviation of depression and UPPS. However, the pooled analysis of eight randomised clinical trials showed similar efficacy of duloxetine (an SNRI) and paroxetine (an SSRI) in reducing UPPS in depression. Further integrative studies examining genetic factors (e.g. polymorphisms of genes for interleukins, serotonin transporter and receptors), molecular factors (e.g. cytokines, substance P) and neuroimaging findings (e.g. functional studies during painful stimulation) might provide further explanation of the pathophysiology of UPPS in MDD and therefore facilitate the development of more effective methods of treatment.
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Affiliation(s)
- Jan Jaracz
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Szpitalna str 27/33, 60-572, Poznan, Poland.
| | - Karolina Gattner
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Szpitalna str 27/33, 60-572, Poznan, Poland
| | - Krystyna Jaracz
- Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
| | - Krystyna Górna
- Department of Neurological and Psychiatric Nursing, Poznan University of Medical Sciences, Poznan, Poland
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Novick D, Montgomery WS, Aguado J, Peng X, Brugnoli R, Haro JM. Which somatic symptoms are associated with an unfavorable course in Chinese patients with major depressive disorder? Asia Pac Psychiatry 2015; 7:427-35. [PMID: 26047023 DOI: 10.1111/appy.12189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 04/21/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This was an analysis of the impact of somatic symptoms on the severity and course of depression in Chinese patients treated for an acute episode of major depressive disorder (MDD). METHODS Data were extracted from a 3-month prospective observational study which enrolled 909 patients with MDD in psychiatric care settings; this analysis focused on the Chinese patients (n=300). Depression severity was assessed using the Clinical Global Impression of Severity (CGI-S) and 17-item Hamilton Depression Rating Scale (HAMD-17); somatic symptoms were assessed using the patient-rated 28-item Somatic Symptom Inventory (SSI). Cluster analysis using baseline SSI scores grouped patients into three clusters with no/mild, moderate, or severe somatic symptoms. Four SSI factors (pain, autonomic symptoms, energy, and central nervous system) were defined, and regression analyses identified which factors were associated with remission at 3 months. RESULTS More than 70% of the patients had moderate or severe somatic symptoms. Baseline depression severity (HAMD-17 and CGI-S scores) was associated with more severe somatic symptoms. Remission rates differed between clusters of patients: 84.1%, 72.0%, and 55.3% for no/mild, moderate, and severe somatic symptoms, respectively (P=0.0034). Pain symptoms were the somatic symptoms more strongly associated with lower remission rates at 3 months. DISCUSSION Somatic symptoms are associated with greater clinical severity and lower remission rates. Among somatic symptoms, pain symptoms have the greatest prognostic value and should be taken into account when treating patients with depression.
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Affiliation(s)
| | | | - Jaume Aguado
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
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Demyttenaere K, Donneau AF, Albert A, Ansseau M, Constant E, van Heeringen K. What is important in being cured from depression? Discordance between physicians and patients (1). J Affect Disord 2015; 174:390-6. [PMID: 25545606 DOI: 10.1016/j.jad.2014.12.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 01/06/2023]
Abstract
AIMS The comparison of what physicians and patients consider important in being cured from depression. METHODS 426 outpatients (in primary care and in psychiatric care) with a clinical diagnosis of major depression were included: at the start of antidepressant treatment, the importance of a range of items for being cured from depression (depressive, anxious and somatic symptoms, positive affect, functional impairment, quality of life) was assessed in physicians and patients separately and a ranking was made; after 3 months of treatment, the importance of these items for being cured from depression was re-assessed in the patients. RESULTS The items ranked top 10 by physicians mainly contain depressive symptoms while those ranked top 10 by patients mainly contain positive affect items and this attention to positive affect even increases at 3 months follow-up and is higher in patients with recurrent depression than in patients with a first episode of depression. Somatic symptoms consistently get the lowest ranking, as well in physicians as in patients. CONCLUSIONS Physicians differ significantly from patients in what they consider important for 'being cured from depression': physicians mainly focus on alleviation of depressive symptoms while patients mainly focus on the restoration of positive affect.
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Affiliation(s)
- Koen Demyttenaere
- University Psychiatric Centre, University of Leuven, Campus Gasthuisberg, Leuven, Belgium.
| | - Anne-Françoise Donneau
- Department of Medical Informatics and Biostatistics, University of Liège, CHU, Sart Tilman, Liège, Belgium
| | - Adelin Albert
- Department of Medical Informatics and Biostatistics, University of Liège, CHU, Sart Tilman, Liège, Belgium
| | - Marc Ansseau
- Department of Psychiatry and Medical Psychology, University and CHU of Liège, CHU, Sart-Tilman, Liège, Belgium
| | - Eric Constant
- Department of Psychiatry, Catholic University of Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Kees van Heeringen
- University Department of Psychiatry and Medical Psychology, Unit for Suicide Research, University of Ghent Hospital, Ghent, Belgium
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Comparison of the effects of escitalopram and nortriptyline on painful symptoms in patients with major depression. Gen Hosp Psychiatry 2015; 37:36-9. [PMID: 25480462 DOI: 10.1016/j.genhosppsych.2014.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 10/12/2014] [Accepted: 10/14/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Unexplained painful physical symptoms are commonly reported by depressed patients. The evidence suggests that dual-action antidepressants are potent in relieving pain in depression. However, a direct comparison of the effects of selective serotonergic and selective noradrenergic antidepressants on painful symptoms has not been investigated so far. METHOD Sixty patients who participated in the Genome-based Therapeutic Drugs for Depression study with a diagnosis of moderate or severe episodes of depression according to the International Classification of Diseases, 10th Revision, and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were involved. All the participants were randomly allocated to receive nortriptyline or escitalopram. The severity of depression was measured using the Montgomery-Åsberg Depression Rating Scale, the Hamilton Depression Rating Scale and the Beck Depression Inventory at weeks 0, 2, 4, 6 and 8. The intensity of pain was measured on the Visual Analog Scale at the same points of the study. RESULTS At "week 0," 83.3% of the patients later randomized to treatment with escitalopram and 86.7% of those treated with nortriptyline reported at least one painful symptom. A significant decrease of pain intensity was observed after 2 weeks of treatment. The two groups did not differ in degree of pain reduction at weeks 2, 4, 6 and 8 in comparison to baseline values. A 50% reduction in pain intensity preceded the 50% reduction of depression severity. The intensity of pain at "week 0" did not differ in remitted or nonremitted patients at week 8. CONCLUSION Both selective serotonergic and selective noradrenergic antidepressants are equally effective in alleviations of painful physical symptoms of depression. The presence of painful symptoms before the onset of treatment did not determine the final response.
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Hung CI, Liu CY, Chen CY, Yang CH, Wang SJ. The impacts of migraine and anxiety disorders on painful physical symptoms among patients with major depressive disorder. J Headache Pain 2014; 15:73. [PMID: 25382691 PMCID: PMC4236854 DOI: 10.1186/1129-2377-15-73] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/03/2014] [Indexed: 01/03/2023] Open
Abstract
Background No study has simultaneously investigated the impacts of migraine and anxiety disorders on painful physical symptoms (PPS) among patients with major depressive disorder (MDD). The study aimed to investigate this issue. Methods This open-label study enrolled 155 outpatients with MDD, who were then treated with venlafaxine 75 mg per day for four weeks. Eighty-five participants with good compliance completed the treatment. Migraine was diagnosed according to the International Classification of Headache Disorders. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale (VAS) was used to evaluate the severity of eight PPS. Multiple linear and logistic regressions were used to investigate the impacts of migraine and anxiety disorders on PPS. Results Compared with patients without migraine, patients with migraine had a greater severity of PPS at baseline and post-treatment. After controlling for demographic variables and depressive severity, migraine independently predicted the intensities of eight PPS at baseline and four PPS post-treatment. Moreover, migraine independently predicted poorer treatment responses of chest pain and full remission of pains in the head, chest, neck and/or shoulder. Anxiety disorders predicted less full remission of pains in the abdomen and limbs. Conclusion Migraine and anxiety disorders have negative impacts on PPS among patients with MDD. Integrating the treatment of migraine and anxiety disorders into the management of depression might help to improve PPS and the prognosis of MDD.
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Affiliation(s)
| | | | | | | | - Shuu-Jiun Wang
- Department of Neurology, National Yang-Ming University School of Medicine and Taipei Veterans General Hospital, No, 201 Shi-Pai Road, Section 2, Taipei 112, Taiwan.
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Lenox-Smith A, Macdonald MTB, Reed C, Tylee A, Peveler R, Quail D, Wildgust HJ. Quality of Life in Depressed Patients in UK Primary Care: The FINDER Study. Neurol Ther 2013; 2:25-42. [PMID: 26000214 PMCID: PMC4389033 DOI: 10.1007/s40120-013-0006-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To investigate the impact of depression and its treatment on health-related quality of life (HRQoL) in a naturalistic, primary care setting in the UK. METHODS The Factors Influencing Depression Endpoints Research (FINDER) study was a European, 6-month, prospective, observational study designed to estimate HRQoL in patients with a clinical diagnosis of depression. This paper examines primary care patients recruited in the UK. HRQoL was measured at baseline and at 3 and 6 months after starting antidepressant therapy using the Short Form 36 Health Status Survey and the European Quality of Life-5 Dimensions (EQ-5D). Regression analysis was used to identify baseline and treatment variables independently and significantly associated with HRQoL. Further analyses included the effect of caseness for depression on HRQoL, the effect of moderate/severe pain at baseline on HRQoL, changes in overall pain, pain interference scores, and the use of different antidepressants by pain cohort. RESULTS A total of 608 patients was recruited from 58 centres and mean HRQoL was significantly below reported population norms at baseline. Most improvement in HRQoL was seen at 3 months for EQ-5D, with small additional improvement at 6 months. Worse HRQoL outcomes at 6 months were associated with higher somatic symptoms score, duration of depression at baseline, and switching within antidepressant classes. Patients meeting the criteria for caseness for depression, or with significant pain at baseline showed less improvement in HRQoL scores at 6 months. CONCLUSION Patients presenting with depression in primary care show reduced HRQoL compared to population norms. HRQoL improves during antidepressant treatment particularly within the first 3 months. Nonpainful somatic symptoms, socioeconomic factors, depression variables and switching within antidepressant class predict poor HRQoL outcome. Pain is a common symptom in depressed patients and remains after 6 months' treatment. Pain and somatic symptoms should be assessed in all patients with depression in primary care.
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Affiliation(s)
- Alan Lenox-Smith
- Eli Lilly & Company Ltd., Lilly House, Priestley Road, Basingstoke, Hampshire RG24 9NL UK
| | - Mark T. B. Macdonald
- Eli Lilly & Company Ltd., Lilly House, Priestley Road, Basingstoke, Hampshire RG24 9NL UK
| | - Catherine Reed
- Eli Lilly & Company Ltd., Erl Wood Manor, Windlesham, Surrey GU20 6PH UK
| | - Andre Tylee
- Health Services and Population Research Department, Section of Primary Care Mental Health, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
| | - Robert Peveler
- Clinical Neurosciences Division, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK
| | - Deborah Quail
- Eli Lilly & Company Ltd., Erl Wood Manor, Windlesham, Surrey GU20 6PH UK
| | - Hiram J. Wildgust
- Hiram Consulting Ltd., 11 Cricketers Close, Ackworth, Pontefract, West Yorkshire, WF7 7PW UK
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Which somatic symptoms are associated with an unfavorable course in Asian patients with major depressive disorder? J Affect Disord 2013; 149:182-8. [PMID: 23521872 DOI: 10.1016/j.jad.2013.01.020] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 01/24/2013] [Accepted: 01/26/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the impact of somatic symptoms on the severity and course of depression in Asian patients treated for an acute episode of major depressive disorder (MDD). METHODS Three-month prospective observational study of 917 patients with MDD in psychiatric care settings of which 909 had complete main baseline data. Depression severity was assessed using the physician-rated Clinical Global Impression of Severity (CGI-S) and 17-item Hamilton Depression Rating Scale (HAMD17), and somatic symptoms were assessed using the patient-rated 28-item Somatic Symptom Inventory (SSI). Cluster analysis using baseline SSI scores grouped patients into 3 clusters with no/few, moderate or severe somatic symptoms. Four factors of SSI (pain, autonomic symptoms, energy, and central nervous system) were defined and regression analyses identified which factors were associated with remission and response at 3 months follow-up. RESULTS Baseline depression severity (HAMD17 and CGI-S scores) was associated with more severe somatic symptoms. Remission rates differed between clusters of patients: 68.4%, 54.7% and 29.3% for no/few, moderate and severe somatic symptoms, respectively (p<0.0001). Corresponding response rates were 81.8%, 72.1% and 55.2% (p<0.0001). Pain symptoms were the somatic symptoms most associated with these clinical outcomes at 3 months. LIMITATIONS Only patients diagnosed with MDD in psychiatric care were assessed. CONCLUSIONS Somatic symptoms are frequent among Asian patients in psychiatric care for MDD and are associated with greater clinical severity and lower response and remission rates. Among somatic symptoms, pain symptoms have the greatest prognostic value and should be taken into account when treating patients with depression.
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Taloyan M, Alinaghizadeh H, Löfvander M. Short-term cognitive-behavioral treatment in multicultural primary care of patients with longstanding backache. Scand J Psychol 2013; 54:371-5. [PMID: 23742650 DOI: 10.1111/sjop.12061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 04/01/2013] [Indexed: 11/28/2022]
Abstract
The efficacy of cognitive-behavioral therapy in multi-cultural primary care patients with longstanding backache is not evaluated. The purpose of this study was to investigate the outcome of a four weekly-treatment given by primary care physicians regarding pain-related worry, depression and severe pain and to determine which social, clinical or gender factors were associated with outcome.The study group consisted of 245 patients in consecutive order from 19 countries, 18 to 45 years, entering rehabilitation program because of longstanding backache. Prevalences of pain-related worry and depression and severe pain was counted and compared before and after. Logistic regression was used to calculate the odds (OR; 95% CI) for persistent pain-related worry and/or persistent depression and severe pain (VAS ≥ 50). The prevalences of pain-related worry and depression were both significantly lower after treatment (pain-related worry 83% before vs. 38% after; depression 43% before vs. 31% after). Also the number of patients scoring ≥ 50 VAS was a little, but significantly, fewer (68% vs. 61%). Use of interpreter doubled the risk of having persistent pain-related worry (OR 2.1; 95% CI 1.1-4.1) but the risk was not significant regarding persistent depression (OR 1.8; 0.6-5.4). The rating of VAS rating ≥ 50 after treatment was twice as high, OR 2.3 (95% CI 1.1-4.6) in the 38-45 year old age group. To conclude, a focus on pain ideas reduced pain-related worry and depression in these patients with various sociocultural backgrounds and longstanding backache.
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Affiliation(s)
- Marina Taloyan
- Centre for Family and Community Medicine, Karolinska Institutet, Sweden.
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The influence of physical activity on pain thresholds in patients with depression and multiple somatoform symptoms. Clin J Pain 2013; 28:782-9. [PMID: 22699138 DOI: 10.1097/ajp.0b013e318243e2d1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Pain is a common symptom with high occurrence in somatoform syndromes and depressive disorders. Research in this area often focuses on experimental induction of pain and subsequent assessment of pain thresholds, ensuring repeatable stimuli of defined quality. Results on sensitivity to experimental pain in major depression are inconclusive, and data on pain thresholds in multiple somatoform symptoms are scarce. The goals of the present study were to differentiate between groups regarding the pressure pain thresholds, and to investigate the possible influence of physical activity on the pain thresholds in these groups. We postulate that physical fitness and physical activity influence pain thresholds in depression and persons with multiple somatoform symptoms. METHODS Thirty-eight persons with major depression, 26 persons with a minimum of 6 to 8 somatoform symptoms (somatoform symptom index 8, SSI-8), and 47 healthy participants participated in the study. Baseline values of pressure pain thresholds assessed at different sites of the body were compared with those after 1 week of increased and 1 week of reduced physical activity. RESULTS We used repeated measurement design (MANCOVA) and partial correlations for data analysis. Depressed participants reported lower pain thresholds compared with controls, and persons with SSI-8 showed intermediate thresholds. After 1 week of physical activity, participants reported higher pain thresholds. Men had higher pain thresholds following activity as compared with women. Participants who reported higher general fitness also showed higher pain thresholds. Sensitivity to pressure pain is associated with depression, but not with multiple somatoform symptoms. DISCUSSION Short low-graded exercise can have reducing effects on perception of pressure pain. Physical activity level is a relevant covariate when using pressure pain assessment. Reduced general fitness can partially account for lower pain thresholds in depression.
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Reed C, Hong J, Novick D, Lenox-Smith A, Happich M. Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database. CLINICOECONOMICS AND OUTCOMES RESEARCH 2013; 5:37-47. [PMID: 23355787 PMCID: PMC3552476 DOI: 10.2147/ceor.s38323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the impact of pain severity and time to diagnosis of depression on health care costs for primary care patients with pre-existing unexplained pain symptoms who subsequently received a diagnosis of depression. Patients and methods This retrospective cohort study analyzed 4000 adults with unexplained pain (defined as painful physical symptoms [PPS] without any probable organic cause) and a subsequent diagnosis of depression, identified from the UK General Practice Research Database using diagnostic codes. Patients were categorized into four groups based on pain severity (milder or more severe; based on number of pain-relief medications and use of opioids) and time to diagnosis of depression (≤1 year or>1 year from PPS index date). Annual health care costs were calculated (2009 values) and included general practitioner (GP) consultations, secondary care referrals, and prescriptions for pain-relief medications for the 12 months before depression diagnosis and in the subsequent 2 years. Multivariate models of cost included time period as a main independent variable, and adjusted for age, gender, and comorbidities. Results Total annual health care costs before and after depression diagnosis for the four patient groups were higher for the groups with more severe pain (£819–£988 versus £565–£628; P < 0.001 for all pairwise comparisons) and highest for the group with more severe pain and longer time to depression diagnosis in the subsequent 2 years (P < 0.05). Total GP costs were highest in the group with more severe pain and longer time to depression diagnosis both before and after depression diagnosis (P < 0.05). In the second year following depression diagnosis, this group also had the highest secondary care referral costs (P < 0.01). The highest drug costs were in the groups with more severe pain (P < 0.001), although costs within each group were similar before and after depression diagnosis. Conclusion Among patients with unexplained pain symptoms, significant pain in combination with longer time from pain symptoms to depression diagnosis contribute to higher costs for the UK health care system.
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Affiliation(s)
- Catherine Reed
- Global Health Outcomes, Eli Lilly and Company, Windlesham, Surrey, UK
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Abstract
PURPOSE OF REVIEW The recent resurgence of the notion of psychosomatic disorders, grouping together as 'medically unexplained symptoms' all those without organic diagnosis and associated with distress, has included all chronic (persistent) pain within its remit. As pain is reasonably well explained, within an integrated biopsychosocial model, critical analysis of the position is required. RECENT FINDINGS Neuroscientific and translational studies of pain mechanisms have strengthened the understanding of pain, providing stronger connections between abstract psychological concepts corresponding to observation and studies of human clinical populations, neuroscientific findings in clinical and analogue studies, and animal research. This situation is contrasted with even the most recent reviews of medically unexplained symptoms providing only vague and patchily supported mechanisms, with little cognate human analogue or animal research. SUMMARY The implication of subsuming chronic pain under medically unexplained symptoms is that the primary care/community physician will try to persuade the patient that the symptoms indicate underlying depression, which her or she may offer to treat. When pain is instead recognized as a problem in its own right, it would be referred for specialist opinion and care, or treated directly with evidence-based pain interventions.
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Wilhelm S, Boess FG, Hegerl U, Mergl R, Linden M, Schacht A, Schneider E. Tolerability aspects in duloxetine-treated patients with depression: Should one use a lower starting dose in clinical practice? Expert Opin Drug Saf 2012; 11:699-711. [PMID: 22712514 DOI: 10.1517/14740338.2012.699521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study questions whether a lower starting dose of duloxetine (DLX) could be beneficial for patients with depression, in terms of tolerability and safety in routine clinical care. RESEARCH DESIGN AND METHODS Post-hoc analyses of a multicenter, prospective, non-interventional, 6-month study in adult outpatients with a depressive episode was undertaken. MAIN OUTCOME MEASURES Treatment-emergent adverse events (TEAEs), serious adverse events (SAEs), discontinuations due to TEAEs and hospitalizations due to depression, were all documented at 2 weeks, 4 weeks, 3 months and 6 months after treatment initiation/switch to DLX. RESULTS Of 4517 patients enrolled, 4313 were included for TEAE evaluation. TEAEs occurred in 17.2% of patients, and SAEs occurred in 0.79% of patients, including one case of suicidal ideation. 1404 patients discontinued within 6 months (TEAEs: n = 119). Starting treatment with 30 mg/day DLX (72.7%) was favored in females, or after inadequate efficacy of previous antidepressant treatment; 60 mg/day DLX was favored in more severe depression and patients receiving concomitant pain medication. CONCLUSION Initiating treatment with 60 mg/day DLX was not associated with poorer tolerability in this study. Physicians may be guided by their clinical experience to carefully consider the individual benefit/risk ratio and TEAE susceptibility when deciding to start treatment with a higher or a lower dose of DLX.
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Affiliation(s)
- Stefan Wilhelm
- Medical Department, Neuroscience, Lilly Deutschland GmbH, Werner-Reimers-Strasse 2-4, 61352 Bad Homburg, Germany.
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Depression treatment with duloxetine and reduction of inability to work. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:264854. [PMID: 22919474 PMCID: PMC3419398 DOI: 10.1155/2012/264854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 06/05/2012] [Accepted: 06/08/2012] [Indexed: 11/18/2022]
Abstract
Data on inability to work from an observational study in patients treated with duloxetine for major depressive disorder in clinical practice in Germany were collected. Ability to work was compared between baseline and up to 6 months after initiation of duloxetine. All patients with a working status at baseline other than retired or retired early were included. 2,825 patients were analyzed, 54.8% were able to work at baseline increasing to 83.8% at 6 months. Of those patients unable to work at baseline, 72.7% were able to work after 6 months. A relevant reduction of inability to work was also found for patient subgroups with moderate to severe pain at baseline and those with and without MDD pretreatment. As inability to work is one of the main cost drivers for depressive patients in Germany, the reduction of inability to work could potentially result in considerable cost savings for health insurance companies and society.
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Examining the role of positive and negative affect in recovery from spine surgery. Pain 2011; 153:518-525. [PMID: 22119337 DOI: 10.1016/j.pain.2011.10.012] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 09/21/2011] [Accepted: 10/06/2011] [Indexed: 11/24/2022]
Abstract
Consistent evidence supports a significant association between lower positive affect and higher negative affect and increased pain and disability in adults with chronic pain. However, examining this relation in surgical populations has received little empirical consideration. The primary purpose of this study was to determine whether preoperative and postoperative positive and negative affect predict pain, disability, and functional status after spine surgery. A secondary objective was to assess the relation of depression to postoperative outcomes compared with positive and negative affect. Participants were 141 patients treated by spine surgery for lumbar or cervical degeneration. Data collection occurred at baseline and 6 weeks and 3 months postoperatively. Affect was measured with the Positive and Negative Affect Schedule. Multivariable mixed-model linear regression analyses found that preoperative variables were not predictive of postoperative pain, disability and functional status. However, multivariable postoperative analysis found that 6-week positive affect predicted functional status, and 6-week negative affect predicted pain interference and pain-related disability at 3 months following surgery. Postoperative depression demonstrated statistically significant and stronger associations with pain intensity, pain interference, and pain-related disability at 3-month follow-up, as compared with negative affect. Results suggest that positive affect and depression are important variables to target when seeking to improve postoperative outcomes in a spine surgery population. Recommendations include postoperative screening for positive affect and depression, and treating depression as well as focusing on rehabilitation strategies to bolster positive affect so as to improve functional outcomes after spine surgery.
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Demyttenaere K, Ansseau M, Constant E, Albert A, Van Gassen G, van Heeringen K. Do general practitioners and psychiatrists agree about defining cure from depression? The DEsCRIBE™ survey. BMC Psychiatry 2011; 11:169. [PMID: 21999407 PMCID: PMC3205021 DOI: 10.1186/1471-244x-11-169] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 10/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to document the outcome dimensions that physicians see as important in defining cure from depression. The study also aimed to analyse physicians' attitudes about depression and to find out whether they affect their prescribing practices and/or the outcome dimensions that they view as important in defining cure. METHODS A 51-item questionnaire based on six validated scales was used to rate the importance of several depression outcome dimensions. Physicians' attitudes about depression were also assessed using the Depression Attitude Scale. Overall, 369 Belgian physicians (264 general practitioners [GPs]; 105 psychiatrists) participated in the DEsCRIBE™ survey. RESULTS GPs and psychiatrists strongly agreed that functioning and depressive symptomatology were most important in defining cure; anxious and somatic symptomatology was least important. GPs and psychiatrists differed in their attitudes about depression (p <0.001). Logistic regression revealed that the attitudes of GPs - but not psychiatrists - were significantly associated with their rates of antidepressant prescription (p < 0.001) and that certain attitudes predicted which outcome dimensions were seen as important in defining cure. CONCLUSIONS Belgian GPs and psychiatrists strongly agreed on which criteria were important in defining cure from depression but differed in their attitudes about depression. The outcome dimensions that were considered important in defining cure were influenced by physicians' attitudes - this was more pronounced in GPs than in psychiatrists.
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Affiliation(s)
- Koen Demyttenaere
- University Psychiatric Centre, Catholic University of Leuven, Campus Gasthuisberg, B-3000 Leuven, Belgium.
| | - Marc Ansseau
- Department of Psychiatry and Medical Psychology, University and CHU of Liège, CHU Sart-Tilman (B35), B-4000, Liège, Belgium
| | - Eric Constant
- Department of Psychiatry, Catholic University of Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Adelin Albert
- Department of Medical Informatics and Biostatistics, University of Liège, CHU Sart Tilman, B-4000 Liège, Belgium
| | - Geert Van Gassen
- Medical Department, Lundbeck Belgium, Avenue Molièrelaan 225, B-1050 Brussels
| | - Kees van Heeringen
- University Department of Psychiatry and Medical Psychology, Unit for Suicide Research, University of Ghent Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
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Schneider E, Linden M, Weigmann H, Wagner T, Quail D, Hundemer HP, Hegerl U. Early reduction in painful physical symptoms is associated with improvements in long-term depression outcomes in patients treated with duloxetine. BMC Psychiatry 2011; 11:150. [PMID: 21933428 PMCID: PMC3184053 DOI: 10.1186/1471-244x-11-150] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 09/20/2011] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To investigate the association of the change of painful physical symptoms (PPS) after 4 weeks, with the 6-month treatment outcomes of depressive symptoms in patients treated with duloxetine in clinical practice. METHODS Multicenter, prospective, 6-month, non-interventional study in adult outpatients with a depressive episode and starting treatment with duloxetine. Depression severity was assessed by the clinician (Inventory for Depressive Symptomatology [IDS-C]) and patient (Kurz-Skala Stimmung/Aktivierung [KUSTA]). Somatic symptoms and PPS were assessed using the patient-rated Somatic Symptom Inventory (SSI) and visual analog scales (VAS) for pain items. Association of change in PPS with outcomes of depressive symptoms was analyzed based on mean KUSTA scores (mean of items mood, activity, tension/relaxation, sleep) and achievement of a 50% reduction in the total IDS-C score after 6 months using linear and logistic regression models, respectively. RESULTS Of the 4,517 patients enrolled (mean age: 52.2 years, 71.8% female), 3,320 patients (73.5%) completed the study. 80% of the patients had moderate to severe overall pain (VAS > 30 mm) at baseline. A 50% VAS overall pain reduction after 4 weeks was associated with a 13.32 points higher mean KUSTA score after 6 months, and a 50% pain reduction after 2 weeks with a 6.33 points improvement. No unexpected safety signals were detected in this naturalistic study. CONCLUSION Pain reduction after 2 and 4 weeks can be used to estimate outcomes of long-term treatment with duloxetine. PPS associated with depression have a potential role in predicting remission of depressive symptoms in clinical practice.
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Affiliation(s)
- Edith Schneider
- Lilly Deutschland GmbH, Medical Department, Bad Homburg, Germany.
| | - Michael Linden
- Research Group Psychosomatic Rehabilitation at the Charité, University Medicine Berlin and the Rehabilitation Centre Seehof, Teltow/Berlin, Germany
| | - Harald Weigmann
- Boehringer Ingelheim Pharma GmbH & Co KG, A Medizinische Wissenschaft, Ingelheim am Rhein, Germany
| | - Thomas Wagner
- Lilly Deutschland GmbH, Medical Department, Bad Homburg, Germany
| | - Deborah Quail
- Dept European Medical Information Sciences, Eli Lilly and Co Ltd, Windlesham, UK
| | | | - Ulrich Hegerl
- Department of Psychiatry, University of Leipzig, Germany
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Dickinson BD, Head CA, Gitlow S, Osbahr AJ. Maldynia: pathophysiology and management of neuropathic and maladaptive pain--a report of the AMA Council on Science and Public Health. PAIN MEDICINE 2011; 11:1635-53. [PMID: 21044254 DOI: 10.1111/j.1526-4637.2010.00986.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Because of disparate taxonomic arrays for classification, the American Academy of Pain Medicine has proposed categorizing pain on a neurobiologic basis as eudynia (nociceptive pain), Greek for "good pain," or maldynia (maladaptive pain), Greek for "bad pain." The latter has been viewed as maladaptive because it may occur in the absence of ongoing noxious stimuli and does not promote healing and repair. OBJECTIVE To address recent findings on the pathogenesis of pain following neural injury and consider whether the development of maladaptive pain justifies its classification as a disease and to briefly discuss the scope of pharmacologic and non-pharmacologic approaches employed in patients with such pain. METHODS English language reports on studies using human subjects were selected from a PubMed search of the literature from 1995 to August 2010 and from the Cochrane Library. Further information was obtained from Internet sites of medical specialty and other societies devoted to pain management. RESULTS Neural damage to either the peripheral or central nervous system provokes multiple processes including peripheral and central sensitization, ectopic activity, neuronal cell death, disinhibition, altered gene expression, and abnormal sprouting and cellular connectivity. A series of neuro-immune interactions underlie many of these mechanisms. Imaging studies have shown that such damage is characterized by functional, structural, and chemical changes in the brain. Such pain is maladaptive in the sense that it occurs in the absence of ongoing noxious stimuli and does not promote healing and repair. CONCLUSION As defined, maldynia is a multidimensional process that may warrant consideration as a chronic disease not only affecting sensory and emotional processing but also producing an altered brain state based on both functional imaging and macroscopic measurements. However, the absolute clinical value of this definition is not established.
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Affiliation(s)
- Barry D Dickinson
- Council on Science and Public Health, American Medical Association, Chicago, Illinois 60654, USA.
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The Factors Influencing Depression Endpoints Research (FINDER) study: final results of Italian patients with depression. Ann Gen Psychiatry 2010; 9:33. [PMID: 20670396 PMCID: PMC2923127 DOI: 10.1186/1744-859x-9-33] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 07/29/2010] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Factors Influencing Depression Endpoints Research (FINDER) is a 6-month, prospective, observational study carried out in 12 European countries aimed at investigating health-related quality of life (HRQoL) in outpatients receiving treatment for a first or new depressive episode. The Italian HRQoL data at 6 months is described in this report, and the factors associated with HRQoL changes were determined. METHODS Data were collected at baseline, 3 and 6 months of treatment. HRQoL was measured using components of the 36-item Short Form Health Survey (SF-36; mental component summary (MCS), physical component summary (PCS)) and the European Quality of Life-5 Dimensions (EQ-5D; visual analogue scale (VAS) and health status index (HSI)). The Hospital Anxiety and Depression Scale (HADS) was adopted to evaluate depressive symptoms, while somatic and painful physical symptoms were assessed by using the 28-item Somatic Symptom Inventory (SSI-28) and a VAS. RESULTS Of the initial 513 patients, 472 completed the 3-month observation and 466 the 6-month observation. The SF-36 and EQ-5D mean (+/- SD) scores showed HRQoL improvements at 3 months and a further smaller improvement at 6 months, with the most positive effects for SF-36 MCS (baseline 22.0 +/- 9.2, 3 months 34.6 +/- 10.0; 6 months 39.3 +/- 9.5) and EQ-5D HSI (baseline 0.4 +/- 0.3; 3 months 0.7 +/- 0.3; 6 months 0.7 +/- 0.2). Depression and anxiety symptoms (HADS-D mean at baseline 13.3 +/- 4.2; HADS-A mean at baseline 12.2 +/- 3.9) consistently decreased during the first 3 months (8.7 +/- 4.3; 7.5 +/- 3.6) and showed a further positive change at 6 months (6.9 +/- 4.3; 5.8 +/- 3.4). Somatic and painful symptoms (SSI and VAS) significantly decreased, with the most positive changes in the SSI-28 somatic item (mean at baseline 2.4 +/- 0.7; mean change at 3 months: -0.5; 95% CI -0.6 to -0.5; mean change at 6 months: -0.7; 95% CI -0.8 to -0.7); in 'interference of overall pain with daily activities' (mean at baseline 45.2 +/- 30.7; mean change at 3 months -17.4; 95% CI -20.0 to -14.8; mean change at 6 months -24.4; 95% CI -27.3 to -21.6) and in 'having pain while awake' (mean at baseline 41.1 +/- 29.0; mean change at 3 months -13.7; 95% CI -15.9 to -11.5; mean change at 6 months -20.2; 95% CI -22.8 to -17.5) domains. The results from linear regression analyses showed that the antidepressant switch within classes was consistently associated with a worsening in SF-36 MCS, EQ-5D VAS and HSI compared to non-switching treatment. Furthermore, between-group antidepressants (AD) switch was associated with a worse SF-36 MCS and EQ-5D HSI. MCS (P = 0.028), PCS (P = 0.036) and HSI (P = 0.002) were inversely related to the number of each previous additional depressive episode. PCS (P = 0.009) and HSI (P = 0.005) were also less improved in patients suffering from a chronic medical condition. Moreover, PCS (P = 0.044) and EQ-5D VAS (P < 0.0001) worsening was consistently associated with the presence of a psychiatric illness in the 24 months before baseline. For every additional point on the SSI-somatic score and on the overall pain VAS score at baseline, HSI score were on average 0.062 (P < 0.001) and 0.001 (P = 0.005) smaller, respectively. CONCLUSIONS After starting AD treatment, HRQoL improvements at 3 and 6 months were observed. However, several factors can negatively influence HRQoL, such as the presence of somatic and painful symptoms, the presence of any chronic medical condition or previous psychiatric illness.
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