Are antidepressants also pain relievers? – Harvard Health Blog

Did you know that antidepressants are often prescribed for people without depression?

That is true. Antidepressants are frequently prescribed for chronic pain, especially pain related to nerve disease (called neuropathic pain), chronic low back pain or neck pain, and some types of arthritis.

In fact, some guidelines for the treatment of chronic low back pain and arthritis (the most common type of arthritis) include antidepressants. One particular antidepressant, duloxetine (Cymbalta), is approved by the FDA for these conditions.

Fair How? ‘Or’ What antidepressants reduce pain is not well understood. One possibility is that they affect chemicals in the brain involved in the perception of pain, a mechanism that is different from how they fight depression.

It is usually not the first choice for pain relief

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

When prescribed for pain, the starting dose is usually low (often lower than the starting dose for depression). It is gradually increased if necessary. Ideally, people will notice benefit within weeks of starting treatment and the drug can be continued at the lowest effective dose. Switching to a different antidepressant may be recommended if the pain is not well controlled, if side effects develop, or if there is an interaction with another drug.

New study suggests antidepressants don’t work well for common types of pain

Previous research on antidepressants for chronic pain, such as duloxetine for osteoarthritis of the knee, amitriptyline or duloxetine for chronic low back pain, and amitriptyline for chronic neck pain, has shown modest short-term benefit. But the studies were limited: most trials were small and only lasted a few months or less. Notably, side effects of the drugs, such as nausea, constipation, and erectile dysfunction, were common in these trials.

Now a Study 2021 combined data from previous research to get a better idea of ​​the safety and effectiveness of antidepressants in these conditions. The news is not good:

• On average, treatment with antidepressants minimized pain and disability compared to placebo. The improvement in pain – about 4 points on a scale of 0 to 100 – was found to be too small to be noticeable.
• People being treated with certain antidepressants for chronic pain often stop taking the drug because it doesn’t work, has unacceptable side effects, or both.
• People with both chronic pain and depression experienced no more improvement than people with only chronic pain.

Sciatica can be an exception: antidepressants can reduce pain for up to a year. However, the quality of previous research was poor, so the study authors were unsure of these findings.

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

The bottom line

The available evidence suggests that, on average, the benefit of antidepressants for OA or chronic low back pain and neck pain is modest at best and tends to be temporary. This is disappointing because, for many people with pain, there are no effective and reliable treatments (except joint replacement for osteoarthritis).

So if you’re taking an antidepressant for pain and you’re not sure if it’s working, ask your doctor if you should consider stopping it. But don’t stop on your own. There may be other reasons your doctor recommends this medicine, and many antidepressants need to be gradually reduced, not stopped all at once, to avoid stop symptoms.

If you’re taking an antidepressant for pain, it’s worth reviewing if it really works for you, and if maybe it’s time to shorten your medication list. Not only could you simplify your medical plan, but you can also reduce your drug cost and the risk of drug-related side effects.

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