DEPRESSION AND PAIN
Pain and depression may occur concomitantly. Chronic pain may exacerbate depression. Chronic pain may be exacerbated by depression. The relative contribution and effect of each illness can be difficult to determine. Patients may not appreciate being questioned about symptoms of depression when they are consulting about symptoms of pain, but it is valuable to obtain a relevant history of symptoms of depression as a consequence of pain. In practice there is a risk that asking specific questions about depression may lead to a patient drawing a conclusion that the clinician is not taking the symptom of pain seriously. There is also a risk that important symptoms may be missed by the pain clinician. A multidisciplinary approach to patients who appear to be depressed may be of value. Conversely, expert opinion from a pain clinician about effective therapy may be valuable for the psychiatrist who otherwise may be tempted to explain the pain symptoms in terms of a depressive illness. There is a third reason for close liaison. This is that while antidepressant drugs are useful analgesics in a number of painful conditions, the most effective of these (tricyclics) have side effects and are dangerous in cases of an overdose. In general terms, a clear diagnosis of depression requires proper and safe management of depression, even if this means antidepressant drugs which have limited analgesic effectiveness. An attempt to treat pain and depression simultaneously with one drug such as a tricyclic antidepressant may be possible, but the risk of overdose should be assessed and managed before this is done.