Stefan  Gebhardt,
The neurobiology of depression and the dilemma of pain treatment
Neurology and Neurobiology
2018
2613-7828
http://dx.doi.org/10.31487/j.NNB.2018.10.007
https://www.sciencerepository.org/the-neurobiology-of-depression-and-the-dilemma-of-pain-treatment_NNB-1-107 
Abstract: Pain is a known side symptom of a depressive disorder. A recent meta-analysis suggests strongly that
treatment of comorbid pain in primary depressive disorders is a treatment of the depressive disorder itself.
This seems to be mostly independent of the treatment method. However, it is essential that the depressive
disorder is treated successfully.
For the individual patient, this means that the choice of antidepressant is based on the individual effect/side
effect profile, not on a supposedly better analgesic effect of antidepressants. As well, psychotherapeutic
strategies and complementary therapies, such as music therapy, are highly recommended depending on the
individual case. The improvement of the affective system leads to the normalization of the pain system
resulting in a relief of pain. Of course, this does not preclude additional suitable analgesic therapy, which
in turn may have effects on depression.
Although this approach seems to be strongly evident, it is hardly implemented in practice. A number of
obstacles seem to interfere with the establishment of appropriate general and individual therapeutic
strategies and lead to a dilemma in pain management of depressive patients: research and publication bias,
obstacles in areas of expertise and professionals’ interests as well as in psychopathology itself are discussed
in this paper.
Keywords: Pain, depressive disorders, neurobiology, antidepressants, psychotherapy, psychosomatics