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Benefits of Antidepressants in Fibromyalgia

Tricyclic antidepressants were effective in reducing pain, fatigue, and sleep disturbances.

Antidepressants commonly are prescribed for patients with fibromyalgia (FM), even for those who don’t meet criteria for clinical depression, but the magnitude of benefit associated with antidepressant therapy is unclear. In a meta-analysis, German investigators examined data from 18 randomized controlled trials of antidepressants for FM treatment that met criteria for high methodological quality (combined enrollment, 1427 subjects; mean study duration, 8 weeks).

Tricyclic antidepressants (TCAs) in small doses (12.5–50 mg daily) had large effect sizes for reducing pain, fatigue, and sleep disturbances; the average benefit in treated subjects was greater than that experienced by about 90% of controls. Compared with TCAs, the effect sizes for selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and serotonin norepinephrine reuptake inhibitors (SNRIs) for reducing pain and other endpoints were smaller. Median rates of adverse effects were roughly similar in treated and control subjects.

Comment: Whereas antidepressants of all categories provide moderate pain relief to FM patients, TCAs provide the most pain benefit and reduce fatigue and sleep disturbances as well. Currently, duloxetine (Cymbalta) — an SNRI — is the only antidepressant approved for use in patients with FM, but, in this analysis, SNRIs had a smaller effect on pain than did the other classes.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine January 22, 2009

Citation(s):

Häuser W et al. Treatment of fibromyalgia syndrome with antidepressants: A meta-analysis. JAMA 2009 Jan 14; 301:198.

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