SAARBRUCKEN, Germany—Some antidepressants can reduce pain, improve sleep, elevate depressed mood, and improve health-related quality of life (HRQOL) in fibromyalgia patients, according to a meta-analysis published in the January 14 issue of the Journal of the American Medical Association.1

Key fibromyalgia antidepressant findings:
  • Low doses of TCAs (tricyclic antidepressants) were very effective at reducing pain, fatigue, and sleep disturbances
  • Low-dose TCAs had little effect on depressed mood
  • MAO (monoamine oxidase) inhibitors had a modest effect on pain
  • SSRIs (selective serotonin reuptake inhibitors) were somewhat effective for reducing pain and depressed moods
  • SSRIs had no effect on fatigue or sleep
  • SNRIs (serotonin-noradrenaline reuptake inhibitors) were somewhat effective for reducing pain, sleep disturbances, and depressed mood

Next: find out which fibromyalgia patient responds to which antidepressant

“The identification of patient characteristics associated with positive and negative therapeutic outcomes are needed to better target antidepressant therapy for fibromyalgia.”—Winfried Häuser, MD

”[T]he identification of patient characteristics associated with positive and negative therapeutic outcomes are needed to better target antidepressant therapy for fibromyalgia,” concluded researchers who were led by Winfried Häuser, MD, of Germany's Saarbrucken Hospital.

The meta-analysis included 18 randomized controlled trials comprising 1,427 patients. Overall, there was strong evidence for a reduction of pain, fatigue and depressed mood and improved sleep and HRQOL with the use of antidepressants by patients with fibromyalgia. Nine different agents including 2 tricyclics (TCAs), 3 selective serotonin reuptake inhibitors (SSRIs), 2 serotonin and noradrenaline reuptake inhibitors (SNRIs), and 2 monoamine oxidase inhibitors (MAOIs). Only 1 antidepressant, Cymbalta® (duloxetine hydrochloride), has been specifically approved for the treatment of fibromyalgia.

“It is currently unknown whether benefits of antidepressants for treatments of fibromyalgia persist after cessation of therapy [and] it is also unknown whether antidepressants reduce fibromyalgia related costs,” the researchers write. “Since evidence for a long-term effect of antidepressants in fibromyalgia is still lacking, their effects should be re-evaluated at regular intervals to determine whether benefits outweigh adverse effects.”

Reference

1. Häuser W, Bernardy K, Uceyler N, Sommer C. Treatment of fibromyalgia syndrome with antidepressants: a meta analysis. JAMA. 2009;301:198-209