Antidepressants Can Help

Good News

Good news comes to fibromyalgia patients by way of an article published in the January 14, 2009 issue of the Journal of the American Medical Association (JAMA). The article reports on an analysis of previous studies conducted on the use of antidepressant medication for patients with fibromyalgia syndrome (FMS). It seems that these medications have been found to reduce pain, help patients get better sleep, and lift their depression. In general, it was found that the use of antidepressant medication for these patients is associated with an overall improvement in their health-related quality of life.

FMS brings chronic pain and sensitivity to several locations of the body and is often accompanied by other symptoms, such as sleep disturbances, and chronic fatigue. The syndrome affects 0.5-5.8% of all North Americans and Europeans. The authors of the new study comment, “Patients with FMS experience disability and reduced health-related quality of life (HRQOL). Fibromyalgia syndrome is also associated with high direct and indirect disease-related costs. Effective treatment of FMS is therefore necessary for medical and economic reasons.”

Meta-analysis

A research team headed up by Winfried Hauser, M.D., of the Klinikum Saarbrucken, in Germany, used a meta-analysis to discover whether antidepressant medication was effective for the symptoms of fibromyalgia. The scientists began by identifying controlled and randomized trials of such medications for FMS and found a total of 18 such trials with a combined total of 1,427 participants. The data suggests that a reduction of fatigue, depression, and sleep disturbances as well as an increase in health-related quality of life is associated with the use of antidepressants in sufferers of FMS.

In comparing the relative merits of the various medications, researchers found that tricyclic and tetracyclic antidepressants (TCAs) had major impact in the reduction of pain, fatigue, and sleep disturbances, while selective serotonin reuptake inhibitors (SSRIs) had a slight positive effect in the reduction of pain. Serotonin and noradrenaline reuptake inhibitors (SSRIs) were seen to have a small impact on pain reduction, sleep disturbances, and depression, while monoamine oxidase inhibitors (MAOIs) had some slight impact on pain reduction.

Careful History

The authors of the study note that before treatment is begun with antidepressants, a careful history must be obtained to rule out any potential adverse effects of these medications on the various ailments which accompany individual cases of FMS. The patient’s preferences must also be taken into account, since a personal distaste relating to the use of such medications may impact treatment. It’s the view of these scientists that the goal of this therapy should be defined for the patient so that it is understood that a cure is not possible, but only a reduction in symptoms.

Because the long term effects of these medications in FMS patients is as yet undocumented, periodic evaluations of the patients should be undertaken to see whether the medication continues to bring benefits, and if any adverse reactions have accrued. The researchers hope that further study of the FMS patients’ responses to antidepressants will bring about further enlightenment on the use of antidepressant therapy for fibromyalgia.