Does Pain Interfere with Antidepressant Depression Treatment Response and Remission in Patients with Depression and Pain? An Evidence-Based Structured Review

作者：Fishbain David A^*; Cole Brandly; Lewis John E; Gao Jinrun

来源：Pain Medicine, 2014, 15(9): 1522-1539.

DOI：10.1111/pme.12448

• Depression
• Major Depression
• Pain
• Chronic Pain
• Depression Response
• Depression Remission
• Antidepressants
• Antidepressant Treatment
• Evidence Based
• Structured Review

ObjectiveThe objective of this evidence-based structured review was to determine if there is consistent evidence that pain interferes with achieving antidepressant treatment response/remission of depression in patients with depression and pain.
MethodsAfter exclusion criteria were applied, of 2,801 studies/reports, 17 studies addressed this question. They were sorted into the four hypotheses outlined hereinafter. The percentage of studies supporting/not supporting each hypothesis was calculated. The strength and consistency of the evidence for each hypothesis were rated according to the Agency for Health Care Research and Quality (AHRQ) guidelines.
ResultsFor the first hypothesis (pretreatment pain levels will predict antidepressant depression response), nine out of 10 (90%) studies supported it. For the second hypothesis (treatment decreases in pain will be associated with antidepressant depression response), two out of two (100%) studies supported it. For the third hypothesis (pretreatment pain levels will predict antidepressant depression remission), six out of six (100%) studies supported it. For the fourth hypothesis (treatment decreases in pain will be associated with antidepressant depression remission), five out of five (100%) supported it. Utilizing these percentages and AHRQ guidelines, hypotheses 1, 3, and 4 received an A rating for consistency of studies in supporting them. A consistency rating for hypothesis 2 could not be generated because of too few studies in that group.
ConclusionsConsistent evidence was found that antidepressant treatment of depression in patients with depression and pain can be negatively impacted by pain for achieving depression response/remission. However, the overall number of studies supporting each hypothesis was small. In addition, several potential confounders of the results of this study were identified.

• 出版日期2014-9