Table of Contents
Antidepressants
The main classes of antidepressants used for treating fibromyalgia are tricyclics, selective serotonin-reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). Although these drugs are antidepressants, doctors prescribe them to improve sleep and relieve pain in non-depressed patients with fibromyalgia. The dosages used for managing fibromyalgia are generally lower than dosages prescribed for treating depression. If a patient has depression in addition to fibromyalgia, higher doses may be required.
Tricyclics. Tricyclic antidepressants were the first drugs to be well-studied for fibromyalgia. They may be more effective than SSRIs and SNRIs for fibromyalgia symptoms, although all three drug classes seem to show some effectiveness. Tricyclics cause drowsiness and can be helpful for improving sleep. Research finds that they are also effective for reducing pain, and improving depressed mood and quality of life. The tricyclic drug most commonly used for fibromyalgia is amitriptyline (Elavil, Endep), which produces modest benefits with pain and sleep but can lose effectiveness over time. Other tricyclics include nortriptyline (Pamelor, Aventyl), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), and amoxapine (Asendin).
Generally, only small doses of tricyclic antidepressants are needed to relieve fibromyalgia. Therefore, although tricyclics have several side effects, these side effects may be less frequent in fibromyalgia patients than in those taking tricyclics for depression. Side effects most often reported include:
- Blurred vision
- Difficulty urinating
- Dizziness
- Drowsiness
- Dry mouth
- Heart rhythm disturbances
- Sexual dysfunction
- Weight gain
As with all medications, tricyclic antidepressants must be taken as directed. An overdose can be life threatening.
Unfortunately, not all patients respond to tricyclics, and the effects wear off in some patients, sometimes after only a month.
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Review Date: 12/27/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital.
Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M.,
Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
