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

Psychosomatics. 2008 May-Jun;49(3):191-8. doi: 10.1176/appi.psy.49.3.191.


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-generation antidepressant over another in patients with pain accompanying depression.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.
  • Review
  • Systematic Review

MeSH terms

  • Antidepressive Agents, Second-Generation / therapeutic use*
  • Depression* / drug therapy
  • Depression* / epidemiology
  • Depression* / physiopathology
  • Duloxetine Hydrochloride
  • Health Status*
  • Humans
  • Pain / diagnosis*
  • Pain / epidemiology*
  • Pain Measurement
  • Paroxetine / therapeutic use*
  • Thiophenes / therapeutic use*


  • Antidepressive Agents, Second-Generation
  • Thiophenes
  • Paroxetine
  • Duloxetine Hydrochloride