Dr. Adams
01-17-2009, 11:05 AM
"Evidence from a meta-analysis of 18 trials of antidepressants in the treatment of fibromyalgia syndrome (FMS) shows that these drugs can improve FMS-associated symptoms of pain, sleep disturbance, depressed mood, and health-related quality of life (HRQOL). However, effect sizes vary significantly between classes of antidepressants.
Overall, there was strong evidence for a reduction of FMS symptoms with antidepressant use. However, effect sizes on pain with different classes of antidepressants varied, with small effect sizes associated with use of selective serotonin-reuptake inhibitors (SSRIs) and serotonin- and noradrenalin-reuptake inhibitors (SNRIs), medium effect sizes with use of monoamine oxidase inhibitors (MAOIs), and large effect sizes associated with tricyclic and tetracyclic antidepressants (TCAs).
Fibromyalgia, which is estimated to affect 0.5% to 5.8% of people in North America and Europe, is characterized by widespread pain and tenderness as well as fatigue and nonrestorative sleep, the researchers write.
Antidepressants are the drugs most often studied for treatment of FMS, and some antidepressants (TCAs and SNRIs) have an analgesic effect independent of their effect on depressed mood; that is, patients may experience a reduction in pain even if they are not depressed.
The researchers found that amitriptyline had a large effect on reducing pain, fatigue, and sleep disturbances, a small effect on HRQOL, and no significant effect on mood.
In addition, they found that the SSRIs fluoxetine and paroxetine had a small effect on reducing pain and improving HRQOL but had no effect on fatigue or sleep.
SNRIs duloxetine and milnacipran had a small effect on reducing pain and sleep disturbances, and duloxetine had a small effect on improving mood and HRQOL, but no effect on fatigue.
The MAOIs moclobemide and pirlindole had a small effect on pain reduction. Moclobemide had no effect on sleep or fatigue, and pirlindole did not affect depressed mood.
Short-term use of amitriptyline and duloxetine can be considered for the treatment of pain and sleep disturbances in FMS.
However, before treatment is initiated, potential adverse effects from the drug should be considered, and alternate treatments such as psychotherapy or balneotherapy (treatment with baths) should be discussed"
JAMA. 2009; 301:198-209. Abstract
Overall, there was strong evidence for a reduction of FMS symptoms with antidepressant use. However, effect sizes on pain with different classes of antidepressants varied, with small effect sizes associated with use of selective serotonin-reuptake inhibitors (SSRIs) and serotonin- and noradrenalin-reuptake inhibitors (SNRIs), medium effect sizes with use of monoamine oxidase inhibitors (MAOIs), and large effect sizes associated with tricyclic and tetracyclic antidepressants (TCAs).
Fibromyalgia, which is estimated to affect 0.5% to 5.8% of people in North America and Europe, is characterized by widespread pain and tenderness as well as fatigue and nonrestorative sleep, the researchers write.
Antidepressants are the drugs most often studied for treatment of FMS, and some antidepressants (TCAs and SNRIs) have an analgesic effect independent of their effect on depressed mood; that is, patients may experience a reduction in pain even if they are not depressed.
The researchers found that amitriptyline had a large effect on reducing pain, fatigue, and sleep disturbances, a small effect on HRQOL, and no significant effect on mood.
In addition, they found that the SSRIs fluoxetine and paroxetine had a small effect on reducing pain and improving HRQOL but had no effect on fatigue or sleep.
SNRIs duloxetine and milnacipran had a small effect on reducing pain and sleep disturbances, and duloxetine had a small effect on improving mood and HRQOL, but no effect on fatigue.
The MAOIs moclobemide and pirlindole had a small effect on pain reduction. Moclobemide had no effect on sleep or fatigue, and pirlindole did not affect depressed mood.
Short-term use of amitriptyline and duloxetine can be considered for the treatment of pain and sleep disturbances in FMS.
However, before treatment is initiated, potential adverse effects from the drug should be considered, and alternate treatments such as psychotherapy or balneotherapy (treatment with baths) should be discussed"
JAMA. 2009; 301:198-209. Abstract