Pains as presentation symptoms of depression in liaison psychiatry as evidenced by outcome of clomipramine treatment Two placebo-controlled trials

Two trials with patients suffering form chronic idiopathic pains have been reviewed. In the first trial clomipramine in a dosage of 85 mg daily was compared with placebo in patients who manifested both pain and depression. In the second trial clomipramine in a dosage of 125 mg daily was compared with mianserin (45 mg daily) or placebo in patients with and without a coexisting depression. It was found that clomipramine produced good effect in around 70% of the patients with pain and depression, whereas clomipramine in idiopathic pain without depression was no better than placebo, i.e. an improvement in around 40% of the patients. The outcome of mianserin treatment was somewhere between placebo and clomipramine. The depressive symptoms in these patients had the same construct as that found in major depression, although the severity of each symptom was of a mild degree. The check-list version of the Melancholia Scale is recommended when examining depressive symptoms in patients with chronic idiopathic pain.□...