Depression and chronic pain linked in Stanford study; may influence diagnosis and treatment

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Depression and chronic pain linked in Stanford study; may influence

diagnosis and treatment

For Release: 1/15/03

Media Contact: Amy

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Broadcast Contact: Neale Mulligan

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STANFORD, Calif. -- A persistent, long-lasting headache or an

endlessly painful back may indicate something more serious than a bad

week at the office. A new study finds that people who have major

depression are more than twice as likely to have chronic pain when

compared to people who have no symptoms of depression. This study could

change how depression is diagnosed and treated, say Stanford School of

Medicine researchers.

" This is potentially a really important finding, " said Alan

Schatzberg, MD, the T. Norris Jr. Professor of Psychiatry and

Behavioral Sciences, who participated in the study published in the

January issue of the journal Archive of General Psychiatry. " This will

change how we view pain and depression. "

Schatzberg said previously published research hinted that people

with depression may be more likely to experience chronic pain and that

depressed people with chronic pain may respond better to a class of

drugs that treats both symptoms. If the relationship exists, then pain

may be a symptom that guides doctors to the drugs they prescribe for

depressed patients.

After hearing anecdotal evidence that certain drugs are more

effective in depressed people who also have chronic pain, Schatzberg and

his colleague Maurice Ohayon, MD, PhD, associate professor of psychiatry

and behavioral sciences at the Stanford School of Medicine, tested the

correlation using data collected previously by Ohayon. These data

included information from 18,980 people in five European countries who

agreed to answer health questions over the phone.

Among the participants, 17 percent had chronic pain and 4 percent

had symptoms of major depression; however, 43 percent of those with

major depression also had chronic pain. Of the symptoms, headaches and

backaches were most commonly found in depressed people. People who had

pain for 24 hours were also more likely to have major depression,

indicating that continuous pain increases the likelihood of having a

major depressive disorder diagnosis.

Schatzberg said he had no idea so many of the patients he treated

for depression may also need treatment for chronic pain.

" I was totally shocked, " he said. Now he'll know to ask his

depressed patients if they also have chronic pain that should be

treated, he said. He added that other doctors can monitor their

chronic-pain patients for symptoms of depression.

When doctors first diagnose a person with depression, they use a

checklist that includes symptoms such as changes in mood, appetite and

sleep patterns to determine the severity of the person's depression

along with the appropriate treatment. Schatzberg suspects that the

presence of chronic pain should be added to this list as a symptom for

assessing depression. He said that by more precisely diagnosing a

person's symptoms doctors have a better chance of prescribing medication

that will be effective in that patient.

The question now is which comes first: the depression or the pain.

" We all have a certain amount of pain, " Schatzberg said. " It could be

that the perception of pain is greater in depressed people. " He pointed

out that many people with depression reported more headache, back pain

or limb pain rather than pain stemming from disease.

Schatzberg added that future studies will look at how people with

depression and chronic pain respond to different drugs used to treat

depression.

http://www.stanfordhospital.com/newsEvents/newsReleases/2003/01/depressionPain.h\

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I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org