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 pr
edominance of anxiousness and agitation. This phenomenological concept has
not been considered as a specific construct in modern descriptive classific
ation systems such as DSM-IV or ICD-10. The purpose of this article is to p
rovide an overview of recent partially independent developments in depressi
on 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, toni
c pain. This specific hpyothesis can be tested with modern functional neuro
imaging.