Antidepressants

Antidepressants

Antidepressants often work effectively to treat chronic pain -- even in people who aren't depressed. Several types can help. Learn about using antidepressants for pain or depression. Note in your Journal how these meds affect you.

Conditions: Osteoarthritis, Rheumatoid arthritis, Migraine, Back Pain, Neck Pain, Fibromyalgia, Nerve Pain, Undiagnosed

Symptoms: Difficulty sleeping, depression, muscle weakness, burning, headache, pain, pain with movement, lower back pain, upper back pain, sharp pain, shocking pain, extreme sensitivity, loss of feeling, numbness, tingling

Triggers:

Treatments:

Categories: Meds

Duration

14

Antidepressants

Some people are uncomfortable with the idea of using antidepressants to treat chronic pain, especially if they are not depressed -- they worry that taking them means that the pain is just "in their heads." That's not true at all. Antidepressants work by adjusting chemicals in the brain that affect mood. Some of these same chemicals also play a role in how the body perceives pain signals. Antidepressants can blunt their effects, reducing the pain you feel. but some of these chemicals can take at least several weeks to work for either pain or depression, so try to be patient.   

Prompt: Why antidepressants?

CTA: They may help treat pain, too.

Conditions: Osteoarthritis, Rheumatoid arthritis, Migraine, Back Pain, Neck Pain, Fibromyalgia, Nerve Pain, Undiagnosed

Symptoms:  Difficulty sleeping, depression, muscle weakness, burning, headache, pain, pain with movement, lower back pain, upper back pain, sharp pain, shocking pain, extreme sensitivity, loss of feeling, numbness, tingling
Triggers:

Treatments:  Elavil, amitriptyline, Sinequan, doxepin, imipramine, Tofranil, desipramine, Norpramin, protriptyline, Vivactil, nortriptyline, Pamelor, Aventyl, Prozac, fluoxetine, Zoloft, sertraline, citalopram, Celexa, Effexor, venlafaxine, Cymbalta, duloxetine, desvenlafaxine, Pristiq

Categories: Meds

TCAs for Pain

Tricyclic antidepressants (TCAs) such as Elavil, Endep, Vanatrip (amitriptyline), and Tofranil (imipramine) are older depression meds that also help treat pain. While generally safe, TCAs can have significant side effects, including dry mouth, constipation, blurred vision, weight gain, urinary retention, increased heart rate, drowsiness, sexual problems, decreased blood pressure, and dizziness. TCAs are used often for pain, and they relieve pain at a lower dose than needed for depression.

Prompt: Tricyclic meds.

CTA: Antidepressants may help pain.

Conditions: Osteoarthritis, Rheumatoid arthritis, Migraine, Back Pain, Neck Pain, Fibromyalgia, Nerve Pain, Undiagnosed

Symptoms: Difficulty sleeping, depression, muscle weakness, burning, headache, pain, pain with movement, lower back pain, upper back pain, sharp pain, shocking pain, extreme sensitivity, loss of feeling, numbness, tingling

Triggers:

Treatments: Elavil, amitriptyline, Tofranil, imipramine, Sinequan, doxepin, imipramine, Tofranil, desipramine, Norpramin, protriptyline, Vivactil, nortriptyline, Pamelor, Aventyl

Categories: Meds

SSRI Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) treat depression, and they tend to have more tolerable side effects than tricyclic antidepressants (TCAs). SSRIs can also sometimes be used off label to help treat pain, but they are thought to be generally less effective for that than TCAs. Side effects may include dry mouth, upset stomach, dizziness, drowsiness, anxiety, nervousness, insomnia, and sexual problems. Many of these side effects often go away after taking the drug for awhile.

Prompt: SSRIs.

CTA: Depression meds for pain.

Conditions: Osteoarthritis, Rheumatoid arthritis, Migraine, Back Pain, Neck Pain, Fibromyalgia, Nerve Pain, Undiagnosed

Symptoms: Difficulty sleeping, depression, muscle weakness, burning, headache, pain, pain with movement, lower back pain, upper back pain, sharp pain, shocking pain, extreme sensitivity, loss of feeling, numbness, tingling

Triggers:

Treatments: Prozac, fluoxetine, Zoloft, sertraline, citalopram, Celexa, Lexapro, escitalopram, Paxil, fluvoxamine, Luvox, paroxetine

Categories: Meds

SNRI Antidepressants

Serotonin and norepinephrine reuptake inhibitors (SNIRs) such as Cymbalta (duloxetine), Effexor (venlafaxine), levomilnacipran (Fetzima), and Pristiq (desvenlafaxine) can help treat both depression and pain. SNRIs can help treat back pain, fibromyalgia, nerve pain, and osteoarthritis. Side effects include nausea, dizziness, sleepiness or trouble sleeping, constipation, anxiety, blurred vision or double vision, headache, and sexual problems.

Prompt: SNRIs.

CTA: Treat depression and pain.

Conditions: Osteoarthritis, Rheumatoid arthritis, Migraine, Back Pain, Neck Pain, Fibromyalgia, Nerve Pain, Undiagnosed

Symptoms: Difficulty sleeping, depression, muscle weakness, burning, headache, pain, pain with movement, lower back pain, upper back pain, sharp pain, shocking pain, extreme sensitivity, loss of feeling, numbness, tingling

Triggers:

Treatments: Effexor, venlafaxine, Cymbalta, duloxetine, Pristiq, desvenlafaxine, Fetzima

Categories: Meds

Best Med for You

There are many different antidepressant treatment options, and which one works best for you depends on:

* Whether you need treatment for pain, depression, or both

* The potential for interactions with other medicines you take

* What type of pain you have

* Whether you experience bothersome side effects

* Other symptoms you may have, such as trouble sleeping

* Your overall health

Tell your doctor about any bothersome side effects or symptoms. If one type of depression med doesn't work, another might.

Prompt: Which med is best?

CTA: Find the right antidepressant.

Conditions: Osteoarthritis, Rheumatoid arthritis, Migraine, Back Pain, Neck Pain, Fibromyalgia, Nerve Pain, Undiagnosed

Symptoms: Aching, burning, electric pain, deep pain, muscle pain, nerve pain, pain, pain at night, pain with movement, all over pain, sharp pain, shocking pain, shooting pain, stabbing pain, numbness, pins and needles, prickling, tingling, anxiety, depression, irritability, mood changes, difficulty sleeping

Triggers:

Treatments: Elavil, amitriptyline, Tofranil, imipramine, Sinequan, doxepin, imipramine, Tofranil, Prozac, fluoxetine, Zoloft, sertraline, citalopram, Celexa, Effexor, venlafaxine, Cymbalta, duloxetine, Paxil, paroxetine, fluvoxamine, Luvox, desipramine, Norpramin, protriptyline, Vivactil, nortriptyline, Pamelor, Aventyl, Viibrud, Trintellix, and Fetzima

Categories: Meds

Migraine Med Risks

If you take migraine meds, use care with some depression meds. In 2006, the FDA warned that the combination of triptan migraine meds and SSRI or SNRI antidepressants can potentially lead to "serotonin syndrome." This occurs because these meds can increase serotonin levels in the body. This can cause serious symptoms such as anxiety, confusion, flushing, sweating, shakiness, restlessness, tremors, and low or high blood pressure. Some other types of meds can also cause problems, so talk with your doctor about how to avoid this serious side effect.  

Prompt: Drug interactions.

CTA: Serotonin syndrome.

Conditions: Migraine

Symptoms:  Difficulty sleeping, depression, muscle weakness, burning, headache, pain, pain with movement, lower back pain, upper back pain, sharp pain, shocking pain, extreme sensitivity, loss of feeling, numbness, tingling, chest pain

Triggers:

Treatments:  Elavil, amitriptyline, Tofranil, imipramine, Sinequan, doxepin, imipramine, Prozac, fluoxetine, Zoloft, sertraline, citalopram, Celexa, Paxil, paroxetine, Lexapro, escitalopram, Effexor, venlafaxine, Cymbalta, duloxetine, milnacipran, desvenlafaxine, Fetzima, , Viibryd, Trintellix, Pristiq, desipramine, Norpramin, protriptyline, Vivactil

Categories: Meds

Medication Risks

Do you have heart problems? If so, be sure to tell your doctor. Tricyclic antidepressants (TCAs) can sometimes be risky for people with certain heart problems -- especially older adults. Ask your doctor about your risk for cardiovascular disease and whether it's safe to take TCAs, which sometimes if overdosed can even be fatal.  In men who have an enlarged prostate gland, TCAs also can sometimes cause difficulty with urination.  Discuss any concerns about possible side effects with your doctor.

Prompt: Heart problems?

CTA: Talk to your doctor.

Conditions: Osteoarthritis, Rheumatoid arthritis, Migraine, Back Pain, Neck Pain, Fibromyalgia, Nerve Pain, Undiagnosed

Symptoms:  Difficulty sleeping, depression, muscle weakness, burning, headache, pain, pain with movement, lower back pain, upper back pain, sharp pain, shocking pain, extreme sensitivity, loss of feeling, numbness, tingling, chest pain

Triggers:

Treatments:  Elavil, amitriptyline, Tofranil, imipramine, Sinequan, doxepin, imipramine, Tofranil, desipramine, Norpramin, protriptyline, Vivactil, nortriptyline, Pamelor, Aventyl

Categories: Meds

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on May 25, 2019

Sources

SOURCES:

ACPA Resource Guide to Chronic Pain Medication & Treatment, 2012 Edition.

American Pain Foundation: "Pain Facts and Figures."

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR.

Arthritis Foundation: "Cardiovascular Risk and NSAID Use," "Osteoarthritis,"  "Fibromyalgia: Treatment Options."

Calder, P. American Journal of Clinical Nutrition, June 2006.

CDC: "Arthritis -- Data and Statistics."

Cruccu, G. European Journal of Neurology, 2007.

Dworkin R. Pain, Dec. 5, 2007.

Dworkin, R. American Journal of Medicine, October 2009.

Fieve, R. Bipolar II, Rodale Books, 2006.

Firestein, G. Kelley's Textbook of Rheumatology, 8th ed., W.B. Saunders, 2008.

Flood, J. The American Journal of Managed Care, March 2010.

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