title: Comparison of the effects of escitalopram and nortriptyline on painful symptoms in patients with major depression.
abstract: OBJECTIVE
  Unexplained painful physical symptoms are commonly reported by depressed patients. The evidence suggests that dual-action antidepressants are potent in relieving pain in depression. However, a direct comparison of the effects of selective serotonergic and selective noradrenergic antidepressants on painful symptoms has not been investigated so far.
  
  
  METHODS
  Sixty patients who participated in the Genome-based Therapeutic Drugs for Depression study with a diagnosis of moderate or severe episodes of depression according to the International Classification of Diseases, 10th Revision, and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were involved. All the participants were randomly allocated to receive nortriptyline or escitalopram. The severity of depression was measured using the Montgomery-Åsberg Depression Rating Scale, the Hamilton Depression Rating Scale and the Beck Depression Inventory at weeks 0, 2, 4, 6 and 8. The intensity of pain was measured on the Visual Analog Scale at the same points of the study.
  
  
  RESULTS
  At "week 0," 83.3% of the patients later randomized to treatment with escitalopram and 86.7% of those treated with nortriptyline reported at least one painful symptom. A significant decrease of pain intensity was observed after 2 weeks of treatment. The two groups did not differ in degree of pain reduction at weeks 2, 4, 6 and 8 in comparison to baseline values. A 50% reduction in pain intensity preceded the 50% reduction of depression severity. The intensity of pain at "week 0" did not differ in remitted or nonremitted patients at week 8.
  
  
  CONCLUSIONS
  Both selective serotonergic and selective noradrenergic antidepressants are equally effective in alleviations of painful physical symptoms of depression. The presence of painful symptoms before the onset of treatment did not determine the final response.
authors.affiliation: Department of Adult Psychiatry, Poznań University of Medical Sciences, ul. Szpitalna 27/33 60-572 Poznań, Poland. Electronic address: jjjaracz@gmail.com.
authors.forename: Jan
authors.initials: J
authors.lastname: Jaracz
authors.affiliation: Department of Adult Psychiatry, Poznań University of Medical Sciences, ul. Szpitalna 27/33 60-572 Poznań, Poland.
authors.forename: Karolina
authors.initials: K
authors.lastname: Gattner
authors.affiliation: Department of Computer Science and Statistics Poznań University of Medical Sciences ul. Dąbrowskiego 79 60-529 Poznań, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Moczko
authors.affiliation: Department of Psychiatric Genetics, Poznan University of Medical Sciences, ul. Szpitalna 27/33, 60-572 Poznań, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Hauser
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D000328:Adult; D015283:Citalopram / Q000008:administration & dosage / Q000494:pharmacology*; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000008:administration & dosage / Q000494:pharmacology*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D016896:Treatment Outcome
chemical_list: D018759:Adrenergic Uptake Inhibitors; D015283:Citalopram; D009661:Nortriptyline; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Escitalopram; Major depression; Nortriptyline; Pain