Major depressive disorder (MDD) is the leading cause of disability worldwide. Patients with MDD have high rates of comorbidity with mental and physical conditions, one of which is chronic pain. Chronic pain conditions themselves are also associated with significant disability, and the large number of patients with MDD who have chronic pain drives high levels of disability and compounds healthcare burden. The management of depression in patients who also have chronic pain can be particularly challenging due to underlying mechanisms that are common to both conditions, and because many patients with these conditions are already taking multiple medications. For these reasons, healthcare providers may be reluctant to treat such patients. The Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines provide evidence-based recommendations for the management of MDD and comorbid psychiatric and medical conditions such as anxiety, substance use disorder, and cardiovascular disease; however, comorbid chronic pain is not addressed. In this article, we provide an overview of the pathophysiological and clinical overlap between depression and chronic pain and review evidence-based pharmacological recommendations in current treatment guidelines for MDD and for chronic pain. Based on clinical experience with MDD patients with comorbid pain, we recommend rapidly and aggressively treating depression according to CANMAT treatment guidelines, using antidepressant medications with analgesic properties, while addressing pain with first-line pharmacotherapy as treatment for depression is optimized. We review options for treating pain symptoms that remain after response to antidepressant treatment is achieved.

The aim of this study is to characterize the relationship between major depression and the metabolic syndrome in a large community based sample of Australian men and women aged 26–90 years. A lifetime history of major depression was assessed by telephone interview following the DSM–III-R. A current history of metabolic syndrome was assessed following the United States National Cholesterol Education Program Adult Treatment Panel III (NCEP AP-III) guidelines 1 to 3 years later. Logistic regression was used to estimate the association between depression and the metabolic syndrome, and its component criteria, controlling for age, sex and alcohol dependence. There was no association between a lifetime history of major depression and the presence of the metabolic syndrome. There was a weak association between depression and low high-density lipoprotein cholesterol but not with other component criteria of the metabolic syndrome. Despite calls for interventions directed at depression to reduce the onset of the metabolic syndrome there are important failures to replicate in large samples such as this, no consensus regarding the threshold at which depression may pose a significant risk even allowing for heterogeneity across populations, and no consensus regarding confounders that may explain inter-study differences. The absence of any dosage effect of depression on the associated risk for the metabolic syndrome in other unselected samples does not support a direct causal relationship. The call for intervention studies on the basis of the currently published evidence base is unwarranted.

The document is published in collaboration with the following organisations: the European Society of Emergency Medicine (Leuven); the European Resuscitation Council (Antwerpen); the Air Medical Physician Association (Salt Lake City, US); the German Interdisciplinary Association of Critical Care Medicine; and the German Society of Anaesthesiology and Intensive Care. The document is to be published jointly in the following journals: 1) Trauma Care (ITACCS); 2) Resuscitation; 3) Prehospital and Disaster Medicine; 4) European Journal of Emergency Medicine; 5) Trauma and Emergency Medicine Journal (SA); 6) Emergency Medicine(Norway); 7) JEUR; and 8) Notfall und Rettungsmedizin (Germany).

Foliated to massive hornblende and biotite-bearing tonalite, trondhjemite and granodiorite comprise a terrane of batholithic dimensions in southwestern to central Newfoundland. These rocks intrude and include Ordovician ophiolite fragments and metasedimentary rocks of Fleur de Lys type, and are cut by a suite of Silurian gabbro-diorite and norite and Siluro-Devonian (?) granite intrusions.

A U/Pb (zircon, sphene) age of 456 ± 3 Ma (2σ) and a K/Ar (hornblende) age of 455 ± 14 Ma (previously reported) for a representative least-deformed tonalite of the Southwest Brook Complex indicate that it crystallised and cooled in Caradoc time. A less precise U/Pb (zircon) age of 428 ± 41 Ma (2σ) is measured for tonalitic Cape Ray Granite in southern Newfoundland. On discrimination diagrams which use Rb, Nb and Y contents to infer tectonic setting, these rocks fall in the field of volcanic arc granites. The occurrence of zircon cores with average ages of 1430 + 18/–17 and 1541 ± 173 Ma (2σ) also indicate that the magmas formed in part by partial melting of Proterozoic crust, or sediments derived from such crust. It is suggested that the tonalitic magmas were generated during the Taconic Orogeny in an arc: continent collision zone at the ancient margin of eastern North America.

Tonalitic rocks in western Newfoundland broadly correlative in age and chemistry with the batholith include the Burlington Granodiorite and Hungry Mountain Complex, as well as allochthonous slices of foliated tonalite emplaced over Ordovician platform carbonates W of Grand Lake.