Chronic pain is strongly associated with anxiety and depression symptoms in advanced cancer patients. The comorbidity of pain and depression significally dificults symptom controll and seems to create a noxious feedback mechanism in wich:chronic PAIN > DEPRESSION > more PAIN > DEPRESION. We call this feedback circle as Pain-Depression Syndrome. Mr RA, is a 68-years-old male Caucasian. At the age of 66 an advanced prostatic adenocarcinoma was diagnosed. Bone metastases were concomitantly found. A mild bone pain was treated with tenoxicam 20 mg/day. The pain became more severe. We initially treated the pain with 400 mg/day of tramadol with partial response. A decision to start morphine was discussed. The patient had no history of mental disorder andhis family had no history of mood or anxiety disorder.He was examined by a psychiatrist who diagnosed a major depressive episode (DSM-IV-TR) associated with chronic pain syndrome (Clinical Global Impression-GGI, severity = 5). He was prescribed with amitriptyline starting with 25 mg/day and increasing up to 75 mg/day, at which dose he experienced severe anticholinergic side effects and mild confusion. Then amitriptyline was thus halted, and he was prescribed with tianeptine 12.5 mg three times a day. After a 2 week period he described a remarkable improvement of pain control (7–3 on a analogue visual scale of pain), mood, anxiety and depressive symptoms were also improved (CGI severity = 2; CGI improvement = 1). At 6 months follow-up he had very mild pain complaints and no significant mood or anxiety symptoms.