Virginia Via Research Day Book 2026

Medical Student Research Clinical 22

ANALYSIS OF ANTIDEPRESSANTS IN MANAGING DEPRESSION AND CHRONIC PAIN: UTILIZING DATA FROM THE ALL OF US RESEARCH PROGRAM

Amber Miller, OMS-III; Blaise Costa, MPharm, PhD Corresponding author: amiller01@vt.vcom.edu

VCOM-Virginia, Blacksburg, Virginia

during the same appointment, excluding those with a diagnosis of a depressive disorder. For analysis, data was exported to Excel using the RStudio Cloud Environment. Results: The leading categories of chronic pain patterns discovered include musculoskeletal and generalized pain, indicating that these subtypes were the most common among patients with comorbid depression. Among patients diagnosed with both chronic pain and depressive disorders, the most commonly prescribed antidepressants were bupropion, venlafaxine, fluoxetine, amitriptyline, and sertraline. In contrast, the cohort excluding depressive disorder diagnoses found the most frequent prescriptions written at the same appointment as a chronic pain diagnosis were duloxetine, amitriptyline, trazodone, bupropion, and nortriptyline. Bupropion was the most frequent prescription in cohort 1, indicating it is more likely prescribed for depression. Conversely, duloxetine was the most common antidepressant in cohort 2, demonstrating it is more frequently used for pain management. Duloxetine also demonstrated the broadest utilization across chronic pain categories (25.6%). The

nearly 10-fold reduction in number of prescriptions between the cohorts supports the idea that most patients with chronic pain also suffer from depression. It is notable that despite duloxetine's well-established role in treating both depression and chronic pain, it is ranked second to last in prescription frequency among patients with co-occurring depression and chronic pain. In addition, the primary prescriptions used for pain management of subtypes included amitriptyline for chronic intractable migraine without aura and fibromyalgia, duloxetine for neurogenic claudication, chronic pain syndrome, and persistent pain following a procedure, and trazodone for generalized chronic pain. Conclusion: Patterns of chronic pain management found bupropion was most likely to be prescribed for depressive symptoms in chronic pain patients, whereas duloxetine was more commonly associated with pain management. After the leading antidepressants on the prescription list, the remaining antidepressants were prescribed at relatively similar frequencies. These findings highlight that the efficacy and clinical use of antidepressants may vary significantly among patients depending on the presence of comorbid depression.

Context: Chronic pain is a prevalent ailment affecting a large proportion of the adult population and is often detrimental to physical ability, mental health, and quality of life. Depression and chronic pain are both multifactorial disorders that are linked through shared chemical messengers such as norepinephrine, serotonin, dopamine, and glutamate, which are known to regulate mood and other behaviors. With the concern of side effects and exhaustion of traditional analgesic pathways, antidepressants have become an important alternative and adjunct for chronic pain management. Objective: To determine the difference between antidepressants that were prescribed to primarily treat pain, as opposed to their use for depressive disorders. Methods: Utilizing the NIH: All of Us research database, we collected data for two adult population groups to assess the pattern trends of antidepressant prescriptions for chronic pain. The first cohort included antidepressant prescriptions for patients diagnosed with both chronic pain and a depressive disorder, as compared to the second cohort of patients diagnosed with chronic pain who were prescribed antidepressants

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