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Body Pain and Treatment Response in Late-Life Depression

Received July 21, 2004; revised December 13, 2004; accepted December 21, 2004. From the Intervention Research Center for Late-Life Mood Disorders (JFK,KS,MB,MM,JS,BHM,BP,MAD,CFR), the Intervention Research Center for Affective Disorders (EF,DJK), and the Dept. of Medicine (DW), University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, PA 15213. Please address correspondence and reprint requests to Dr. Jordan F. Karp, Western Psychiatric Institute and Clinic, 3811 O’Hara St., Pittsburgh, PA 15213. e-mail: karpjf{at}upmc.edu
© 2005 American Association for Geriatric Psychiatry

Objective: The authors investigated the influence of body pain on 1) time to treatment response and 2) suicidal ideation, in late-life depression. They hypothesized that higher levels of body pain would predict a longer time to and lower likelihood of response, and increased levels of suicidal ideation. Methods: Subjects (N=187) were older adult outpatients (age 69 years), with current episodes of major depression, who were openly treated with paroxetine up to 40 mg daily and weekly interpersonal psychotherapy. Response was defined as 3 consecutive weeks of Hamilton Rating Scale for Depression at 10. Body pain was measured with the Bodily Pain Index of the SF-36 quality-of-life assessment. Authors used survival-analysis models on the responder sample to test the effect of body pain on response, after controlling for severity of depression. Results: Overall response rate was 75.4%. Nonresponders reported more severe pain at baseline. After covarying for severity of baseline depression, no effect was found for physical pain on time-to-response or degree of suicidality. Bodily pain remained stable during acute treatment for responders, independent of depression response to combination psychotherapy and antidepressant treatment. Conclusions: Older adult patients with higher levels of physical pain can still respond to antidepressant treatment; however, reported bodily pain may be associated with a more difficult-to-treat depression.

Key Words: Depression • Antidepressants • Medical Comorbidity • Physical Pain

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