Effectiveness of Antidepressants to Treat Chronic Pain

Don’t be surprised when doctors recommend antidepressants for chronic pain conditions. Can they really help you relieve pain if you don’t have any depression symptoms? Different classes of antidepressants play an interesting role in treating chronic pain.

How Chronic Pain and Depression Are Linked

It’s not rare for patients with chronic pain conditions, including lupus, neuropathic pain, rheumatoid arthritis and others, to experience depression. If people have chronic health condition, they also have higher rates of major depression. This means that depression and pain are often linked. Besides, many patients with depression also have chronic pain. That’s why people with chronic pain are often prescribed to take antidepressants even without any depression symptoms.

What If There’s No Co-Existing Depression

Although antidepressants are mainly prescribed to improve the mood of patients with clinical depression, because they affect brain neurotransmitters, these meds can be also prescribed as an effective treatment for chronic pain, sleep and anxiety disorders. When they’re taken for chronic pain, they work as adjuvant analgesics, and it means that antidepressants are prescribed with other pain killers instead of being used along to relieve pain.

The exact mechanism of action that helps them relieve pain is unknown, through it seems that it’s unrelated to how they alleviate depression. In general, antidepressants have their effect on such neurotransmitters as norepinephrine and serotonin, especially along spinal pain pathways. They may also work through sodium channels and histamine receptors.

Different Types of Antidepressants

There are certain classes of antidepressants taken by patients with chronic pain. The way they all function may differ, and these classes include:

• MAO inhibitors;
• Tricyclic antidepressants;
• Combined receptor blockers and reuptake inhibitors;
• NDRIs;
• SNRIs;
• SSRIs.

Tricyclic Antidepressants

They were the main treatment for depression before the introduction of SSRIs. Nowadays, tricyclic antidepressants are used less often, but they often work for chronic pain. They are very effective in managing neuropathic back pain, but these drugs are also taken for other pain types. Tricyclic antidepressants include the following:

• Pamelor and Sinequan;
• Elavil and Tofranil;
• Vivactil and Ascendin;
• Norpramin and Surmontil.

When they are taken to treat chronic pain, their doses are much lower than the ones used for depression, so their intake leads to fewer adverse reactions, such as sudden weight gain, blurred vision and increased sleepiness.

Selective Serotonin Reuptake Inhibitors

SSRIs are often prescribed by doctors to treat anxiety and depression, and this class of antidepressants includes:

• Paxil and Prozac;
• Luvox and Zoloft;
• Celexa and Lexapro.

They target serotonin to increase its level in the brain. SSRIs are quite effective drugs for most people, and their adverse reactions are more tolerable and moderate compared to tricyclic antidepressants. Their use for chronic pain conditions without depression is proven to have a positive effect.

Serotonin and Norepinephrine Reuptake Inhibitors

SNRIs are targeted at norepinephrine and serotonin, so they are dual inhibitors. SSRIs and they can help users control their fatigue and pain linked to different chronic pain conditions and fibromyalgia, but SNRIs are more effective when it comes to pain relief. This category of antidepressants includes:

• Savella and Effexor;
• Pristiq and Cymbalta.

The FDA approved Cymbalta to treat fibromyalgia and musculoskeletal pain. However, there are still certain side effects caused by the use of SNRIs, including anxiety, nausea, insomnia, unusual tiredness, headaches and loss of appetite.

Combined Reuptake Inhibitors and Receptor Blockers

They are often taken for different sleep conditions, depression and chronic pain. This class of antidepressants includes:

• Remeron;
• Serzone;
• Desyrel.

Their common adverse reactions include nausea, dry mouth, dizziness and drowsiness. These meds aren’t intended to be taken by patients with liver conditions.

Norepinephrine and Dopamine Reuptake Inhibitors

They form a different class of antidepressants, and bupropion is the most famous NDRI. Their common side effects include nausea, insomnia, headaches, agitation, increased blood pressure and loss of appetite.

Monoamine Oxidase Inhibitors

They are older antidepressants, so they aren’t commonly used for depression and other conditions because of their side effects these days:

• Emsam and Nardil;
• Marplan and Parnate.

There are specific dietary restrictions for consumers taking them because of significant and severe side effects.

Studies about Using Antidepressants to Treat Chronic Pain

According to the latest research, there are certain benefits of taking antidepressants to manage chronic pain conditions in adult patients, especially amitriptyline. However, there’s still only little information about their use for non-cancer related pain in adolescents and kids.

Meds Approved for Chronic Pain and Off-Label Uses

When discussing the effects of antidepressants when treating chronic pain, it’s worth distinguishing meds approved for this use and those drugs that are taken by patients off label. When medicines are approved by the FDA for specific use, this means that their effects are reviewed and studied, and the effectiveness and safety are proven.

Any off-label use is about taking medications approved by the FDA for one health condition for other reasons, including chronic pain.

Warnings when Taking Antidepressants

The intake of antidepressants is associated with certain warnings. The FDA claims that both adults and children should be closely monitored for increased suicidal thoughts, behaviors and depression during the first months of their treatment or after changing their regular doses. It’s necessary to contact doctors right after worsening different depression symptoms when suicidal behaviors and ideas increase. If you take any antidepressants, you should be familiar with all warning signs and risk factors.

Final Words

Antidepressants are quite helpful for patients treating chronic pain conditions in many ways. People who live with chronic pain and fibromyalgia often have depression. The good news is that some antidepressants may provide them with the necessary relief from their chronic pain through different mechanisms. Out of the existing classes of antidepressants, the tricyclic ones, such as amitriptyline, were evaluated carefully, especially when treating neuropathic pain.

It’s difficult to manage chronic pain, because it affects different aspects of life. The right combination of specific drugs, like adding suitable antidepressants, can be the most effective solution, but stress management and non-medication treatments are equally significant.