Effect of carbamazepine on pain scores of unipolar depressed patients with chronic pain: a trial of off-on-off-on design.
OBJECTIVE
The purpose of this study was to evaluate the effect of carbamazepine on chronic pain in patients with major depression.


METHODS
Off-on-off-on carbamazepine treatment design.


METHODS
Department of Anesthesiology, Hirosaki University Hospital, Japan.


METHODS
Fifteen patients with a diagnosis of major depression and chronic pain.


METHODS
Depressed patients maintained on antidepressants that had failed to help depression or pain were initially placed on 450 mg carbamazepine at 150 mg three times per day. Carbamazepine was then increased until the patients experienced satisfactory relief of pain. This dose was then maintained for 3 weeks. Afterward, the medication was stopped, and a lactose placebo was administered orally three times per day for 3 weeks. Thereafter, carbamazepine was given for 3 additional weeks at the dose that previously produced satisfactory pain relief.


METHODS
Pain scores were assessed four times during the course of the study: before and after the first and the second treatments with carbamazepine, using a visual analog scale in which 0 represents no pain and 10 unbearable pain. The Hamilton Depression scale was used to judge improvement in the symptoms of depression.


RESULTS
Carbamazepine produced a statistically significant reduction in the pain scores, from 8.2 +/- 2.3 to 4.0 +/- 1.1 after the first treatment. The pain score significantly increased to 8.0 +/- 1.0 after stopping carbamazepine, but it decreased significantly to 4.1 +/- 1.8 after the second treatment. The Hamilton scores significantly decreased from 27.4 +/- 7.2 to 20.2 +/- 6.1 after the carbamazepine treatment.


CONCLUSIONS
These results may indicate that carbamazepine has both an antidepressive and an analgesic action in depressed patients. Thus, carbamazepine may offer an acceptable therapeutic option in depressed patients with chronic pain that is unresponsive to antidepressants. Alternatively, these results may indicate that carbamazepine appears to help depression in this group of pain patients because of its analgesic effect (i.e., helps depression as a result of helping pain or vice versa).
Kudoh
A
A
Department of Anesthesiology, University of Hirosaki School of Medicine, Aomori, Japan.
Ishihara
H
H
Matsuki
A
A
D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D002220:Carbamazepine / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D003866:Depressive Disorder / Q000150:complications* / Q000523:psychology; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D010147:Pain Measurement; D010919:Placebos; D012107:Research Design
D018712:Analgesics, Non-Narcotic; D010919:Placebos; D002220:Carbamazepine