Can chronic pain be alleviated by anti-depressants?

The question is this: Can chronic pain be alleviated by anti-depressants?

Antidepressants are often prescribed for people who are experiencing chronic pain from such conditions as fibromyalgia and arthritis. Under what conditions should a person with arthritis or fibromyalgia incorporate an antidepressant into their medication regimen? How can these patients be helped by antidepressants?

It is typical for patients with chronic diseases to have bouts of depression. For a great number of patients, depression is only experienced briefly, but for those who continue to have symptoms, professional counseling may be necessary. In addition to counseling, the patient may also be encouraged to use a prescription medication.

SSRI’s: The most commonly prescribed antidepressants come from a family of medications called selective serotonin reuptake inhibitors (SSRIs). Some drugs included in the list of SSRIs are:

• Prozac (fluoxetine)
• Lexapro (escitalopram)
• Celexa (citalopram)
• Zoloft (sertraline)
• Paxil (paroxetine)
• Wellbutrin (bupropion)

As the name implies, SSRIs target a neurotransmitter called serotonin, a chemical produced by the brain. These medications work well and usually have few side effects.

Dual Inhibitors: There is another family of antidepressants called dual inhibitors, which target two of the neurotransmitters, serotonin and norephinephrine.  Dr. Scott Zashin, a rheumatologist, explains that both SSRIs and dual inhibitors are effective when it comes to controlling the fatigue and pain that often accompany fibromyalgia and other chronic pain syndromes. He went on to say that the dual inhibitors might be the more effective of the two when used for this purpose. The two SNRI’s (selective serotonin and norepinephrine reuptake inhibitors), or dual inhibitors that Dr. Zashin discussed were Cymbalta (duloxetine) and Effexor (venlafaxine). Cymbalta is currently under investigation to see if will be effective in the treatment of fibromyalgia.

Tricyclic Antidepressants: Before the advent of SSRIs, tricyclic antidepressants were usually prescribed to treat depression. These medications (e.g. Elavil or amitriptyline), when given in low doses, help people to sleep and to reach the more restful, non-REM phase of sleep. Dr. Zashin says that tricyclic anti-depressants can work very effectively to alleviate discomfort and fatigue. The tricyclics are not often used for this purpose, however, because they are predisposed to causing side effects.

Warnings About Using Antidepressants:  Many warnings accompany the use of antidepressants. According the the Food and Drug Administration, patients who have recently experienced a change in antidepressant medication should be monitored closely for several months. Any patient experiencing deepening symptoms of depression, or suicidal thoughts, behaviors, or gestures, should seek immediate medical help. It is important for patients to be informed of all the possible side effects and report any notable symptoms to their physicians.