Antidepressants and the Treatment of Pain

Friday, August 28, 2009

Individuals with fibromyalgia may wonder why antidepressants are sometimes used to treat their pain, especially if they are not depressed. In addition to depression, antidepressants have been shown to be an effective treatment option for other disorders, including chronic pain, sleep disorders and anxiety disorders. In fact, research from the University Hospital Center and University of Lausanne in Switzerland, which analyzed studies on pain and antidepressants published from 1991 to March 2008, showed that antidepressants are an essential part of the therapeutic strategy when treating chronic pain.

“Antidepressants have been shown to be an effective treatment option for chronic pain, sleep disorders and anxiety disorders.”

For instance, tricyclic antidepressants such as amitriptyline—prescribed at a lower dose than when used to treat depression—have been shown to have a powerful impact on pain symptoms as well as disordered sleep problems. Not all antidepressants are effective for FM symptoms, however; serotonin reuptake inhibitors such as Prozac have not proven effective in the treatment of fibromyalgia pain.

Two medications used to treat depression have even been FDA-approved for the treatment of fibromyalgia. Cymbalta and Savella, serotonin-norepinephrine reuptake inhibitors, are thought to be effective in treating fibromyalgia because of the norepinephrine component. (Though many people have experienced symptom relief through use of these medications, their effectiveness varies from person to person, just like any other treatment option.)

When a healthcare provider prescribes a medication to treat a condition other than the one that medication is designed (or approved) for, that is called “off-label prescribing.” This is a common, medically accepted practice, as in the case of people with fibromyalgia who do not have depression—but have been prescribed an antidepressant. So if your doctor broaches the subject of antidepressants (other than Cymbalta and Savella) with you, listen to the reason why. He may not be assuming that you have depression, but may in fact be offering you an off-label treatment option.