Quality of life and pain in premenopausal women with major depressive disorder: the POWER Study.
BACKGROUND
Whereas it is established that organic pain may induce depression, it is unclear whether pain is more common in healthy subjects with depression. We assessed the prevalence of pain in premenopausal women with major depression (MDD). Subjects were 21- to 45-year-old premenopausal women with MDD (N = 70; age: 35.4 +/- 6.6; mean +/- SD) and healthy matched controls (N = 36; age 35.4 +/- 6.4) participating in a study of bone turnover, the P.O.W.E.R. (Premenopausal, Osteopenia/Osteoporosis, Women, Alendronate, Depression) Study.


METHODS
Patients received a clinical assessment by a pain specialist, which included the administration of two standardized forms for pain, the Brief Pain Inventory - Short Form, and the Initial Pain Assessment Tool, and two scales of everyday stressors, the Hassles and Uplifts Scales. In addition, a quality-of-life instrument, the SF-36, was used. The diagnosis of MDD was established by a semi-structured interview, according to the DSM-IV criteria. Substance P (SP) and calcitonin-gene-related-peptide (CGRP), neuropeptides which are known mediators of pain, were measured every hour for 24 h in a subgroup of patients (N = 17) and controls (N = 14).


RESULTS
Approximately one-half of the women with depression reported pain of mild intensity. Pain intensity was significantly correlated with the severity of depression (r2 = 0.076; P = 0.04) and tended to be correlated with the severity of anxiety, (r2 = 0.065; P = 0.07), and the number of depressive episodes (r2 = 0.072; P = 0.09). Women with MDD complained of fatigue, insomnia, and memory problems and experienced everyday negative stressors more frequently than controls. Quality of life was decreased in women with depression, as indicated by lower scores in the emotional and social well-being domains of the SF-36. SP (P < 0.0003) and CGRP (P < 0.0001) were higher in depressed subjects.


CONCLUSIONS
Women with depression experienced pain more frequently than controls, had a lower quality of life, and complained more of daily stressors. Assessment of pain may be important in the clinical evaluation of women with MDD. SP and CGRP may be useful biological markers in women with MDD.
Hartman
Jill M
JM
National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA. cizzag@intra.niddk.nih.gov.
Berger
Ann
A
Baker
Karen
K
Bolle
Jacques
J
Handel
Daniel
D
Mannes
Andrew
A
Pereira
Donna
D
St Germain
Diane
D
Ronsaville
Donna
D
Sonbolian
Nina
N
Torvik
Sara
S
Calis
Karim A
KA
Phillips
Terry M
TM
Cizza
Giovanni
G
D000328:Adult; D019386:Alendronate / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D015740:Calcitonin Gene-Related Peptide / Q000097:blood; D016022:Case-Control Studies; D003865:Major Depressive Disorder / Q000097:blood / Q000150:complications*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D010146:Pain / Q000150:complications*; D010147:Pain Measurement; D017697:Premenopause / Q000523:psychology*; D011788:Quality of Life; D013315:Stress, Psychological / Q000150:complications; D013373:Substance P / Q000097:blood
D050071:Bone Density Conservation Agents; D013373:Substance P; D015740:Calcitonin Gene-Related Peptide; D019386:Alendronate