The excellent review, "Depression and Pain Comorbidy,"1 fails to mention a very common obstacle to the treatment and overt diagnosis of depression in primary care—the absolute refusal of the patient to accept that diagnosis. In my experience, many patients will not even consider a trial of antidepressants as adjuncts for pain management because of the stigma of a psychiatric disease. Out of fear of angering the patient and jeopardizing the patient-physician relationship, physicians considering this diagnosis may not "officially" make it even if they believe it is present.
Regalbuto G. An Obstacle to the Treatment of Depression. Arch Intern Med. 2004;164(7):804. doi:10.1001/archinte.164.7.804-b