Pain and Depression: A Systematic Review

Harv Rev Psychiatry. 2018 Nov/Dec;26(6):352-363. doi: 10.1097/HRP.0000000000000198.


Background: Pain comorbid with depression is frequently encountered in clinical settings and often leads to significant impaired functioning. Given the complexity of comorbidities, it is important to address both pain and depressive symptoms when evaluating treatment options.

Aim: To review studies addressing pain comorbid with depression, and to report the impact of current treatments.

Method: A systematic search of the literature databases was conducted according to predefined criteria. Two authors independently conducted a focused analysis of the full-text articles and reached a consensus on 28 articles to be included in this review.

Results: Overall, studies suggested that pain and depression are highly intertwined and may co-exacerbate physical and psychological symptoms. These symptoms could lead to poor physical functional outcomes and longer duration of symptoms. An important biochemical basis for pain and depression focuses on serotonergic and norepinephrine systems, which is evident in the pain-ameliorating properties of serotonergic and norepinephrine antidepressants. Alternative pharmacotherapies such as ketamine and cannabinoids appear to be safe and effective options for improving depressive symptoms and ameliorating pain. In addition, cognitive-behavioral therapy may be a promising tool in the management of chronic pain and depression.

Conclusion: The majority of the literature indicates that patients with pain and depression experience reduced physical, mental, and social functioning as opposed to patients with only depression or only pain. In addition, ketamine, psychotropic, and cognitive-behavioral therapies present promising options for treating both pain and depression.

Publication types

  • Systematic Review

MeSH terms

  • Chronic Pain* / epidemiology
  • Chronic Pain* / physiopathology
  • Chronic Pain* / psychology
  • Chronic Pain* / therapy
  • Comorbidity*
  • Depressive Disorder* / epidemiology
  • Depressive Disorder* / physiopathology
  • Depressive Disorder* / psychology
  • Depressive Disorder* / therapy
  • Humans