Antidepressant Treatment for Fibromyalgia

If you are part of the one-third of fibromyalgia patients that deal with depression, you may be prescribed antidepressants to help improve your mood. However, even if you do not have depression, you may still be prescribed antidepressants. Why? Because antidepressant medications can also help relieve symptoms of fibromyalgia.

What are Antidepressants?
Antidepressant medication is typically used to help relieve symptoms of depression. They work on different parts of the brain that control emotion, and help to change brain function so that people feel less depressed. There are three main classes of antidepressants: tricyclics (TCAs), selective serotonin reuptake inhibitors (SSRIs), and serotonin norepinephrine reuptake inhibitors (SNRIs). Each class of antidepressant pills works on different areas in the brain in order to improve mood.

How do Antidepressants Help Treat Fibromyalgia?
Though antidepressant drugs are typically used to treat mood disorders, they have also proven effective in relieving the pain and sleep-related disorders of fibromyalgia. When people with fibromyalgia receive antidepressant prescriptions, it is typically in order to interrupt pain cycles and restore restful sleep. Antidepressants are prescribed in lower-than-usual doses in order to treat these symptoms.

Many people with fibromyalgia also suffer from depression. In these cases, antidepressant medications are prescribed in order to lift mood. However, regular doses of antidepressants are required in order to improve depression.

Types of Antidepressants Available
All three antidepressant types are available for treating fibromyalgia. You should speak with your health care provider in order to determine the best antidepressant for fibromyalgia. Each class is associated with different rates of effectiveness and have different antidepressant side effects.

Tricyclic Antidepressants(TCAs)
Tricyclic antidepressants are among the oldest antidepressants on the market. They work by acting on serotonin and norepinephrine, which are chemicals in the brain that help to transmit messages about pain and emotion. Low levels of these chemicals are associated with depression, fatigue and pain. TCAs work by slowing the breakdown of these chemicals. In low doses, tricyclics are also effective at reducing pain and facilitating restful sleep, both of which are helpful to fibromyalgia patients.

Studies show that TCAs are the best antidepressant drugs for people with fibromyalgia. About 32% of fibromyalgia sufferers experience relief with tricyclics. The most commonly prescribed TCA is amitriptyline; other tricyclics include doxepin, nortriptyline, and cyclobenzaprine. Though TCAs are highly effective, they are also associated with more severe side effects than other, new antidepressant medications. These side effects include: dry mouth, constipation, blurred vision, fatigue, and low blood pressure. People with glaucoma, heart conditions, or seizure disorders should not take TCAs.

Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are one of the newer classes of antidepressants. They are widely prescribed for depression as well as a variety of other ailments. SSRIs work by stopping the breakdown of serotonin in the brain. Serotonin is a neurotransmitter, which helps our brain to communicate pain signals and emotions. SSRIs are highly effective at reducing feelings of depression and anxiety.

SSRIs are used in fibromyalgia in order to improve sleep patterns. People with fibromyalgia often have disturbed sleep, which contributes to fatigue and persistent pain. SSRIs also help to bolster mood in fibromyalgia patients. Commonly prescribed SSRIs include: fluoxetine, paroxetine, and citalopram. SSRIs are not effective for pain relief and therefore are not used as often as TCAs. Recent studies show that SSRIs are most effective when used in combination with a TCA (for instance, fluoxetine and amitriptyline). Side effects of SSRIs are mild. This antidepressant’s drug side effects include nausea, weight gain, anxiety, loss of sex drive, and headaches.

Serotonin Norepinephrine Reuptake Inhibitiors (SNRIs):
SNRIs are very similar to TCAs, as they work on both serotonin and norepinephrine in the brain. However, SNRIs are better able to balance levels of both of these neurotransmitters, leading to fewer side effects. SNRIs are commonly prescribed to alleviate depression and boost energy.

SNRIs are used in fibromyalgia to relieve pain and disability. They are also beneficial for treating symptoms of depression. The most commonly prescribed SNRIs are duloxetine and venlafaxine. SNRIs are sometimes prescribed instead of TCAs because they tend to work faster and cause fewer side effects. Effects of this antidepressant medication include: indigestion, nausea, sexual dysfunction, and loss of balance. SNRIs are not recommended for people with heart conditions.

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