Depression is increasingly seen as a triad of psychological, somatic and physical symptoms that all need to be treated to achieve maximal remission. In primary care, physical symptoms such as pain, are the principal presenting symptoms, and a common psychopharmacology between pain and depression suggests that compounds that inhibit the reuptake of both serotonin and norepinephrine are likely to produce the greatest relief from depression and chronic pain. Recent, principally open, trials with members of the new selective serotonin and norepinephrine reuptake inhibitor class of antidepressants such as venlafaxine, milnacipran and duloxetine (Eli Lilly & Co/Shionogi & Co Ltd), suggest that these compounds may be effective in relieving pain both associated with, and independent of depression.