Antidepressants improve symptoms of fibromyalgia

Jan 14 2009

The use of antidepressant medications by patients with fibromyalgia syndrome is associated with a reduction in pain, sleep disturbances and depressed mood and improvement of health-related quality of life, according to an analysis of previous studies, which is published in the January 14, 2009 issue of JAMA.

Fibromyalgia syndrome (FMS), which consists of chronic widespread pain and tenderness, with other symptoms including fatigue and sleep difficulties, has an estimated prevalence of 0.5 percent to 5.8 percent in North America and Europe. "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," the authors write.

Winfried Häuser, M.D., of Klinikum Saarbrücken, Saarbrücken, Germany, and colleagues conducted a meta-analysis to evaluate the effects of treatment with antidepressants on FMS-related symptoms. The researchers identified 18 randomized controlled trials, involving 1,427 participants, for inclusion in the study.

Overall, there was strong evidence for a reduction of pain, fatigue and depressed mood and improved sleep and HRQOL with the use of antidepressants by patients with FMS.

The researchers found large effect sizes of tricyclic and tetracyclic antidepressants (TCAs) for reducing pain, fatigue, and sleep disturbances; small effect sizes of selective serotonin reuptake inhibitors (SSRIs) for reducing pain; small effect sizes of serotonin and noradrenaline reuptake inhibitors (SNRIs) for reducing pain, sleep disturbances, and depressed mood; and small effect sizes of monoamine oxidase inhibitors (MAOIs) for reducing pain.

"Before treatment is initiated, [accompanying] diseases related to potential adverse effects of the drugs and patients' preferences should be considered. Goals of pharmacological therapy should be defined (no cure, but possible symptom reduction). Since evidence for a long-term effect of antidepressants in FMS is still lacking, their effects should be re-evaluated at regular intervals to determine whether benefits outweigh adverse effects," the authors write. "The identification of patient characteristics associated with positive and negative therapeutic outcomes are needed to better target antidepressant therapy for FMS."