Depression and pain: often together but still a clinical challenge: a review.

Depression is a common mental disorder with various symptoms and often accompanied with unexplained painful physical symptoms. Patients, especially in primary care, often present only with somatic symptoms and depressed mood is overlooked. On the other hand, psychiatrists don't pay enough attention to somatic or painful symptoms in patients with depression. The connection between depression and accompanying painful physical symptoms is not completely understood although some common neurobiological pathways are proposed. To achieve good clinical outcome all depression symptoms should be recognized and treated. In this review we focus on painful physical symptoms which could not be explained by somatic illness or the intensity can not be explained by physical disease and are attributed to somatic symptoms of depression. The aim of this review is to provide the basic necessary information for clinicians/psychiatrists on depression with painful physical symptoms, presenting the terminology, epidemiology, differential diagnostics, neurobiological background, psycho-social aspects and treatment strategies.