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 depression.
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 says.
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 says.
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.