Quality of life and pain in premenopausal women with major depressive disorder: The POWER Study

Jill M Hartman,Sara Torvik,Andrew Mannes,Diane St Germain,Terry M Phillips,Jacques Bolle,Karim A Calis,Daniel Handel,Donna Ronsaville,Karen Baker,Giovanni Cizza,Donna Pereira,Nina Sonbolian,Ann Berger

doi:10.1186/1477-7525-4-2

Jill M Hartman, Sara Torvik + Show 12 more

Open Access

https://doi.org/10.1186/1477-7525-4-2

Copy DOI

Abstract

BackgroundWhereas it is established that organic pain may induce depression, it is unclear whether pain is more common in healthy subjects with depression. We assessed the prevalence of pain in premenopausal women with major depression (MDD). Subjects were 21- to 45-year-old premenopausal women with MDD (N = 70; age: 35.4 +/- 6.6; mean +/- SD) and healthy matched controls (N = 36; age 35.4 +/- 6.4) participating in a study of bone turnover, the P.O.W.E.R. (Premenopausal, Osteopenia/Osteoporosis, Women, Alendronate, Depression) Study.MethodsPatients received a clinical assessment by a pain specialist, which included the administration of two standardized forms for pain, the Brief Pain Inventory – Short Form, and the Initial Pain Assessment Tool, and two scales of everyday stressors, the Hassles and Uplifts Scales. In addition, a quality-of-life instrument, the SF-36, was used. The diagnosis of MDD was established by a semi-structured interview, according to the DSM-IV criteria. Substance P (SP) and calcitonin-gene-related-peptide (CGRP), neuropeptides which are known mediators of pain, were measured every hour for 24 h in a subgroup of patients (N = 17) and controls (N = 14).ResultsApproximately one-half of the women with depression reported pain of mild intensity. Pain intensity was significantly correlated with the severity of depression (r2 = 0.076; P = 0.04) and tended to be correlated with the severity of anxiety, (r2 = 0.065; P = 0.07), and the number of depressive episodes (r2 = 0.072; P = 0.09). Women with MDD complained of fatigue, insomnia, and memory problems and experienced everyday negative stressors more frequently than controls. Quality of life was decreased in women with depression, as indicated by lower scores in the emotional and social well-being domains of the SF-36. SP (P < 0.0003) and CGRP (P < 0.0001) were higher in depressed subjects.ConclusionWomen with depression experienced pain more frequently than controls, had a lower quality of life, and complained more of daily stressors. Assessment of pain may be important in the clinical evaluation of women with MDD. SP and CGRP may be useful biological markers in women with MDD.

Highlights

Whereas it is established that organic pain may induce depression, it is unclear whether pain is more common in healthy subjects with depression
There are few studies of pain prevalence in patients presenting with Major Depressive Disorder (MDD) in whom pain was not the primary complaint [9], whereas it is well established that pain and depression are sometimes so intertwined that it is difficult to determine whether bodily pain precipitated depression or whether the depressive symptoms resulted in pain [10,11]
The aims of the current study were: 1) to establish the prevalence of pain and associated symptoms in premenopausal women with MDD compared to healthy controls; 2) to determine whether there is a relationship between pain intensity and the clinical features of depression; and 3) to examine the relationship of neuropeptides (Substance P (SP) and Calcitonin-Gene-Related-Peptide (CGRP)) to major depression

Summary

Introduction

Whereas it is established that organic pain may induce depression, it is unclear whether pain is more common in healthy subjects with depression. We assessed the prevalence of pain in premenopausal women with major depression (MDD). Subjects were 21- to 45-year-old premenopausal women with MDD (N = 70; age: 35.4 +/- 6.6; mean +/- SD) and healthy matched controls (N = 36; age 35.4 +/- 6.4) participating in a study of bone turnover, the P.O.W.E.R. The prevalence of pain in patients presenting with MDD, in whom pain was not the primary complaint, has not been well characterized. There are few studies of pain prevalence in patients presenting with MDD in whom pain was not the primary complaint [9], whereas it is well established that pain and depression are sometimes so intertwined that it is difficult to determine whether bodily pain precipitated depression or whether the depressive symptoms resulted in pain [10,11]. Pain and depression are both associated with insomnia and altered sleep quality, and impaired quality of life [12]

Objectives

Methods

Results

Discussion

Conclusion