Psychic pain as a symptom of depression. Phenomenology and neurobiology

Abstract

In a review of the relevant literature the experience of pain in depression is emphasized. There is evidence for a central pain disturbance mediating the 'psychic pain' experience in severe major depressive episodes with a predominance of anxiousness and agitation. This phenomenological concept has not been considered as a specific construct in modern descriptive classification systems such as DSM-IV or ICD-10. The purpose of this article is to provide an overview of recent partially independent developments in depression and experimental pain research with emphasis on the neuroanatomy of the rostral limbic system and the medial pain system. The available evidence is consistent with the hypothesis that overlapping anatomic structures of the medial pain system are activated during the experience of both the psychic pain of depression and the motivational-affective component of acute, tonic pain. This specific hypothesis can be tested with modern functional neuroimaging.