Der psychische Schmerz als Symptom der Depression

Zusammenfassung:

In einer Literatur-Übersicht wird die Bedeutung des Schmerzerlebens in der Depression hervorgehoben. Es gibt Hinweise dafür, dass eine Störung der zentralen Schmerzverarbeitung den psychischen Schmerz der Depression vermittelt, besonders wenn Angst und Agitation symptomatisch im Vordergrund stehen. Der Schmerz als phänomenologisches und biologisches Konzept wird in modernen deskriptiven Klassifikationen depressiver Störungen nach DSM-IV oder ICD-10 kaum als spezifisches Konstrukt hervorgehoben. Zweck dieser Arbeit ist es, neuere theoretisch teilweise unabhängige Entwicklungen der Depressions- und Schmerzforschung aufzuzeigen, unter besonderer Berücksichtigung des neuroanatomischen Konzeptes des rostralen limbischen Systems und des medialen Schmerzsystems. Die verfügbare Literatur steht in Einklang mit der Hypothese, dass überlappende anatomische Strukturen des medialen Schmerzsystems sowohl während des psychischen Schmerzerlebens in der Depression als auch während der motivational-affektiven Komponente akuter, tonischer Schmerzen aktiviert sind. Diese spezifische Hypothese kann mittels moderner funktioneller bildgebender Verfahren geprüft werden.

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 hpyothesis can be tested with modern functional neuroimaging.

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