intermediatevenlafaxineSNRIfibromyalgiachronic paindescending pain inhibitionclinical selection
A 48-year-old female presents with a 9-month history of major depressive disorder (PHQ-9 score of 19) and comorbid fibromyalgia with widespread musculoskeletal pain rated 7/10. She previously trialed sertraline 150 mg daily for 10 weeks, which improved her mood modestly (PHQ-9 decreased to 14) but provided no pain relief. She discontinued sertraline due to the persistent pain. Her rheumatologist asks the PMHNP to consider an antidepressant that might address both conditions. Which of the following best supports selecting venlafaxine at a target dose of 150-225 mg daily for this patient?