Pain in Depressive Disorders

For ages pain complaints of patients suffering from depression belong to the everyday challenges of general practitioner. Typical diagnostic designations comprised ‘ dépression larvée ’ or ‘masked depression’ in the past. In some cases, depressive symptoms are masked by pain symptoms and therefore ignored by the physicians. Up to half of the patients suffering from acute depression are not diagnosed as such, possibly because they present with bodily or pain symptoms, respectively, rather than with symptoms classically known for depression. Pain ranks second, only yielding to insomnia, among the somatic and vegetative symptoms of depression and occurs in over 50 % of the patients with depression. Thus, one might wonder why pain carries little weight in the diagnosis of depression. In recent years, pain and somatic symptoms has been considered more and more in psychiatry and psychosomatics as concomitant of depression, and has now become the status of a common comorbidity. While there is good evidence for symptoms of depression in patients with chronic pain according to numerous studies, comparably little is known about the other ‘relation’: the role of pain in depressive disorders. To compensate for this neglect, the focus of this book chapter is laid on pain in depression. This approach appears especially worthwhile in light of the high number of affected patients and their poor prognosis compared to patients with depression but without pain. Chapter 7 Pain in Depressive Disorders