Are antidepressants also pain relievers? Harvard Health Blog


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Did you know that antidepressant medications are often prescribed to people? without depression?

it’s the truth. Antidepressants are often prescribed for chronic pain, especially pain related to nerve diseases (called nerve pain), chronic lower back or neck pain, and certain types of arthritis.

In fact, there are some guidelines for treating chronic lower back pain and in the spine (The most common type of arthritis) includes antidepressants. One antidepressant in particular, duloxetine (Cymbalta), is FDA-approved for these conditions.

Just How Antidepressants reduce pain are not well understood. One possibility is that it affects chemicals in the brain that are involved in perception of pain, a mechanism different from how depression is fought.

It is not usually the first choice for pain relief

For people with low back or chronic neck pain, or osteoarthritis of the hip or knee, antidepressant medications are not usually the first recommended treatment. Other approaches, such as physical therapy, exercise, weight loss, non-steroidal anti-inflammatory drugs (NSAIDs), or cortisone injections are usually tried first. But if these aren’t helpful, an antidepressant like duloxetine or amitriptyline may be a reasonable next step.

When prescribed for pain, the initial dose is usually low (often less than the starting dose for depression). Increase gradually if necessary. Ideally, people notice a benefit within weeks of starting the medication, and the medication can be continued at the lowest effective dose. Switching to a different antidepressant may be recommended if pain is not well controlled, side effects appear, or there is a reaction to another medication.

A new study suggests that antidepressants don’t work well for common types of pain

Previous research on antidepressants for chronic pain, such as: Duloxetine for osteoarthritis of the kneeAnd the Amitriptyline or Duloxetine For chronic lower back pain Amitriptyline for chronic neck pain, Showed modest, short-term benefit. Studies were limited, however: most trials were small and only lasted a few months or less. Notably, drug side effects, such as nausea, constipation and erectile dysfunction, were common in these trials.

Now prof The 2021 study I gathered data from previous research to get a better idea of ​​how safe and effective antidepressants are for these conditions. The news is not good:

  • On average, treatment with an antidepressant reduced pain and disability to a minimum compared to a placebo. The improvement in pain – about 4 points on a scale from 0 to 100 – was considered too small to be noticeable.
  • Often people who have been treated with certain antidepressants for chronic pain stop taking the medication because it did not work, caused unacceptable side effects, or both.
  • People with chronic pain and depression did not feel any better than people with chronic pain alone

Sciatica might be an exception: Antidepressants may have relieved pain for up to a year. However, the quality of previous research was poor, so the study authors were not confident of these conclusions.

These results cast doubt on the usefulness of antidepressant treatment for these common causes of chronic pain. However, they do not rule out the possibility that some individuals will get more relief from these medications than others.

The bottom line

Available evidence suggests that the benefit of antidepressants in treating osteoporosis or chronic low back pain and neck pain is, on average, modest at best and tending to be temporary. This is disappointing because, for many who suffer from pain, there are no reliable effective treatments (except for joint replacement for osteoarthritis).

Therefore, if you are taking an antidepressant for pain and you are not sure if it is working, talk to your doctor about whether you should consider stopping it. But don’t stop it alone. There may be other reasons for your doctor to recommend this medication, and many antidepressants should be reduced gradually, and not stopped at once, to avoid Discontinuation symptoms.

If you are taking an anti-depressant for pain, it is helpful to reconsider whether it really does anything for you and whether it is time to shorten your medication list. Not only can you simplify your medical regimen, but you can also reduce your medication cost and the risk of drug-related side effects.

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