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Randomized Controlled Trial
. 2006 Jan 18:4:2.
doi: 10.1186/1477-7525-4-2.

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

Jill M Hartman  1 , Ann Berger, Karen Baker, Jacques Bolle, Daniel Handel, Andrew Mannes, Donna Pereira, Diane St Germain, Donna Ronsaville, Nina Sonbolian, Sara Torvik, Karim A Calis, Terry M Phillips, Giovanni Cizza; P.O.W.E.R. (Premenopausal, Osteoporosis, Women, Alendronate, Depression) Study Group
Affiliations
Randomized Controlled Trial

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

Jill M Hartman et al. Health Qual Life Outcomes. .

Abstract

Background: 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. (Premenopausal, Osteopenia/Osteoporosis, Women, Alendronate, Depression) Study.

Methods: Patients 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).

Results: Approximately 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.

Conclusion: Women 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.

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Figures

Figure 1
Figure 1
Daily Hassles Scale.
Figure 2
Figure 2
SF-36 Questionnaire. Physical Well-Being Domain: PF = Physical Functioning, RP = Role Physical, BP = Bodily Pain, GH = General Health; Emotional and Social Well-Being Domain: VT = Vitality, SF = Social Functioning, RE = Role Emotional, MH = Mental Health.
Figure 3
Figure 3
SF-36 Physical Composite Scale (PCS) and Mental Composite Scale (MCS).
Figure 4
Figure 4
Plasma levels of Substance P (SP) (upper panel) and calcitonin-gene-related-peptide (CGRP) (lower panel). As indicated in the insets, mean 24-h levels of SP and CGRP were lower in women with depression compared to controls.
See this image and copyright information in PMC

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