Feinmann131 has previously reviewed studies that reported pain relief associated with depression symptom relief. We identified 22 studies6,71,132- 151 that examined antidepressant efficacy for treating pain symptoms and subsequent depression response (Table 4). We did not include studies of symptom syndromes (eg, fibromyalgia, irritable bowel syndrome, migraine headaches) or studies excluding patients with depression or organic pain (eg, diabetic neuropathy, cancer pain) because these conditions have been reviewed previously, and antidepressants were found to be effective.18- 20,152- 153 The primary outcome in all the studies in Table 4 was pain relief or other pain outcomes, while depression symptom relief was one of the secondary outcomes. Sample sizes were relatively small, ranging from 14 to 253. Only 4 studies6,132,137,141 were conducted in a primary care setting, with the remainder situated in pain, psychiatric, and specialty clinics. The intervention arm of each selected study usually involved tricyclic antidepressants, and only 4 studies involved selective serotonin reuptake inhibitors (SSRIs)135,138,143,145 to assess pain and depression. While most of the studies demonstrated improvement in both pain and depression symptoms, a few of the studies132,142,147 failed to show symptom relief. Whether SSRIs improve painful symptoms associated with depression is unsettled. Most studies were uncontrolled, of short duration (averaging 9 weeks), and used doses that were subtherapeutic for adequate depression treatment.