Antidepressants May Help Some Depressed Fibromyalgia Patients
April 6, 2000 (New York) -- Some -- but not necessarily all -- of the
millions of Americans with fibromyalgia may benefit from antidepressants,
according to a review article in the March/April issue of the journal
Psychosomatics. Antidepressants may help elevate mood, improve quality
of sleep, and relax muscles of people with this syndrome.
Fibromyalgia produces chronic, bodywide pain and muscle tenderness. Other
symptoms may include chronic fatigue, headaches, sleep disturbances, and
After reviewing nine studies on an older class of antidepressants called
tricyclics, the researchers, led by Lesley M. Arnold, MD, associate professor
of psychiatry at the University of Cincinnati College of Medicine, report that
25% to 37% of patients with fibromyalgia showed some improvements when treated
with tricyclic antidepressants including Elavil (amitriptyline).
Improvements were most pronounced among individuals with a history of
depression or anxiety, the study found.
"While there is a real need for more study, we do know that if someone
who has [fibromyalgia] and a history of a depression, anxiety, or other mood
disorder, they may be more likely to respond to antidepressant treatment,"
she tells WebMD.
Fibromyalgia patients taking tricyclic antidepressants showed the largest
improvements in sleep quality and modest improvements in muscle stiffness and
tenderness, the studies showed. "Overall the improvements were modest, but
the doses were low," she tells WebMD. "Future studies should look at
higher does of the medications taken for extended periods of time," she
Because tricyclic antidepressants tend to have more side effects than the
newer selective serotonin reuptake inhibitors (SSRIs) antidepressants such as
Prozac (fluoxetine), Arnold and colleagues also looked at two studies on the
use of SSRIs among people with fibromyalgia, as well as two studies of a
popular supplement called SAMe that is used to treat depression.
Although the two studies of SSRIs did not show much improvement for
fibromyalgia patients, "there are some ongoing trials of SSRIs now, which
are better tolerated and have fewer side effects than tricyclics, and I will
say that it looks promising," Arnold says.
And "although studies of SAMe were promising, this agent is not licensed
for clinical use in the U.S., and its [effectiveness] as an antidepressant has
not been definitely established," the researchers write. Other new
fibromyalgia drugs that are on deck affect the central nervous system, she
Other suggested treatments for fibromyalgia include exercise, according to
Nathan Smukler, MD, director of the Fibromyalgia Center at Thomas Jefferson
University College of Medicine in Philadelphia. "Get active," he tells
WebMD. "[Fibromyalgia] patients become limited because they feel that their
pain is aggravated by exercise, and we have to get them moving -- whether
jogging, walking, or using free weights," he says.
- Fibromyalgia is a condition that produces chronic, bodywide pain and muscle
- A review of published research shows that a type of antidepressants known
as tricyclics are moderately effective against fibromyalgia, especially in
patients with a history of depression or anxiety.
- Other trials are ongoing to look at other treatments for fibromyalgia,
including another class of antidepressants known as SSRIs and a dietary
supplement called SAMe.