Korean J Psychopharmacol.  2012 Oct;23(4):176-182.

Comparison of Effect of SSRIs, SNRIs, and NaSSA on Pain

  • 1Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea. hduk70@naver.com


Selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and noradrenergic and specific serotonergic antidepressant (NaSSA) are extensively used to treat the patients with depression. Although depressed patients are complaining of somatic pain as a complication of depression, there has not been any straight-forward comparative data of the effect of SSRIs, SNRIs, and NaSSA on pain. Therefore, in this study, we tried to figure out the effect of each drug i.e.SSRIs, SNRIs, and NaSSA, on pain by administrating each drug to three different groups of patient with depression.
We conducted a chart review of patients, who visited a university hospital. From January, 2010 to February, 2012, total 150 inpatients who had been diagnosed as major depression by Diagnostic and Statistical Manual of Mental Disorders-4th edition criteria, and administered any of three drugs [SSRIs (n=50), SNRIs (n=50), and NaSSA (n=50)] at least for fore weeks in the department of psychiatry in Chung-Ang University Hospital, were enrolled for this study. We compared and analyzed depressive symptoms and pain between three groups. Depressive symptoms and pain were evaluated by Korean version of the Hamilton Depression Rating Scale and visual analogue scale at baseline and fore weeks later.
There was no difference in the age, gender, severity of depression and pain among three groups. However, there was difference in 50% depressive symptomatic improvement rate in the following four weeks among three groups. The number of patient found to achieve 50% symptomatic improvement in SSRIs, SNRIs, and NaSSA group was 17 (34%), 20 (40%), and 34 (54%) in each group, respectively, indicating significantly higher improvement rate in NaSSA compared to SSRIs. During four weeks of administration period, significant difference in 50% pain improvement rate was observed among three groups. The number of patient found to achieve 50% pain improvement in SSRIs, SNRIs, and NaSSA group was 14 (28%), 20 (40%), and 27 (54%) in each group, respectively, showing twice higher pain improvement rate in NaSSA compared to SSRIs.
This result indicates better efficacy of NaSSA on pain improvement compared to SSRIs, and SNRIs in depressed patients. Although the effect of pain improvement has been mainly focused on SNRIs, result from this study suggests the need for further research and validation on the effect of NaSSA for pain control.


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