title: Does pain interfere with antidepressant depression treatment response and remission in patients with depression and pain? An evidence-based structured review.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  After exclusion criteria were applied, of 2,801 studies/reports, 17 studies addressed this question. They were sorted into the four hypotheses outlined herein after. 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.
  
  
  RESULTS
  For 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.
  
  
  CONCLUSIONS
  Consistent 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.
authors.affiliation: Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida, USA; Department of Psychiatry, Miami VA Medical Center, Miami, Florida, USA; The Rosomoff Comprehensive Pain Center, Douglas Gardens Hospital, Miami, Florida, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Fishbain
authors.forename: Brandly
authors.initials: B
authors.lastname: Cole
authors.forename: John E
authors.initials: JE
authors.lastname: Lewis
authors.forename: Jinrun
authors.initials: J
authors.lastname: Gao
mesh_terms: D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015984:Causality; D015986:Confounding Factors, Epidemiologic; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D008962:Models, Theoretical; D064887:Observational Studies as Topic; D010146:Pain / Q000150:complications* / Q000523:psychology; D010147:Pain Measurement; D058748:Pain Perception / Q000187:drug effects; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D057566:Self Report; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: Antidepressant Treatment; Antidepressants; Chronic Pain; Depression; Depression Remission; Depression Response; Evidence Based; Major Depression; Pain; Structured Review