Treating the physical symptoms of depression with second-generation antidepressants: A systematic review and metaanalysis

Background: Approximately two-thirds of patients with depression experience physical pain symptoms. Coexisting pain complicates the treatment of depression and is associated with worse depression outcomes. Objective: The authors reviewed the effect of newer antidepressants on pain in patients with depression. Method: The authors searched systematically for trials of second-generation antidepressants that enrolled depression patients and reported pain outcomes, pooling changes on the pain visual-analog scale (VAS), using random-effects models. Results: Eight trials were eligible. Pooled analysis of head-to-head trials showed no difference in VAS between duloxetine and paroxetine. Both drugs were superior to placebo. Conclusion: The authors found insufficient evidence to support the choice of one second-gene ration antidepressant over another in patients with pain accompanying depression.