Which One Is Right For You?

They Work!

The results are in: antidepressants improve the symptoms of Fibromyalgia Syndrome (FMS). A large scale meta-analysis of some 18 clinical trials involving 1,427 fibromyalgia patients scattered throughout North America, South America and Europe showed that antidepressant drug therapy brought a reduction in pain, sleep disturbances, and depression, in a majority of sufferers. Fibromyalgia is a disorder that is sometimes overlooked during an investigation of a patient's widespread muscle pain and tenderness, even though FMS affects some 12 million people worldwide, almost 11 million of them women.

University of Florida College of Medicine's Roland Staud, a professor of medicine at the Gainesville institution describes the level of disability experienced by sufferers as, "from very little to total," and adds that among his private patients are some who have been confined for bed for periods of up to one year, due to the debilitating symptoms they experience. Such symptoms tend to begin between the ages of 40 and 60, but often remain an issue for the duration of the patients' lives.

Twin Factors

A psychiatrist who is the director of the Women's Health Research Program at the University of Cincinnati's College of Medicine, Leslie Arnold, believes that stress and heredity are twin factors in bringing on a case of fibromyalgia syndrome. Meantime, only two drugs have as yet earned approval from the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia: Cymbalta, a drug produced by Eli Lilly, and Lyrica, made by Pfizer. Cymbalta is one of the antidepressants reviewed in this newest study, and Lyrica serves to control seizures and pain.

German Team

This new study was conducted by a German team, headed up by Winfried Hauser, an internist at the Klinikum Saarbrucken. Hauser states, "All classes of antidepressants had substantial effects on pain [however] we found differences between the classes of antidepressants on other key symptoms of FMS such as sleep disturbances, fatigue, and depressed mood."

Selective serotonin reuptake inhibitors (SSRI's) like Prozac were found to have a great impact on pain reduction and mood improvement, but had no effect on fatigue or sleep issues. Serotonin and noradrenaline reuptake inhibitors (SNRI's) such as Cymbalta improved pain, sleep, and mood, but didn't help with fatigue. Tricyclic and tetracyclic antidepressants (TCA's) like Vanatrip reduced pain, fatigue, and sleep problems. Monoamine oxidase inhibitors (MAOI's) such as Manerix only helped with pain reduction.

Major Advance

Dr. Arnold commented, "This is a major advance. We are trying to identify new treatments for fibromyalgia and raise awareness for this disease."

The director of the rheumatology research division at the Seattle-based Swedish Medical Center, Philip Mease, is concerned that patients will interpret these results as confirming the wrong-headed contention that fibromyalgia stems from depression, and that treating depression will cure this, as yet, incurable disease. Mease says, "I am a crusader against the term 'antidepressant' because they are not used as antidepressants in this context."

Anesthesiologist, Dan Clauw of the Ann Arbor-based University of Michigan agrees with Mease, "The strong implication to the reader is that these people [participants of the study] are getting better because they are depressed. There is pretty overwhelming evidence that these [medications] are not working as antidepressants [but as pain relievers, too]."

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