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Do you know that antidepressant medicines are sometimes prescribed for folks with out despair?

It’s true. Antidepressants are often prescribed for power ache, particularly ache associated to nerve illness (referred to as neuropathic ache), power low again or neck ache, and sure varieties of arthritis.

In truth, some pointers for the remedy of power low again ache and osteoarthritis (the commonest sort of arthritis) embrace antidepressants. One antidepressant specifically, duloxetine (Cymbalta), is FDA-approved for these circumstances.

Simply how antidepressants scale back ache just isn’t nicely understood. One chance is that they have an effect on chemical compounds within the mind concerned in ache notion, a mechanism that differs from how they battle despair.

Not often the primary selection for ache reduction

For folks with power low again or neck ache or osteoarthritis of the hip or knee, an antidepressant medicine just isn’t often the primary remedy really helpful. Different approaches, resembling bodily remedy, train, dropping extra weight, nonsteroidal anti-inflammatory medicine (NSAIDs), or cortisone injections are often tried first. But when these aren’t useful, antidepressants resembling duloxetine or amitriptyline could be an affordable subsequent step.

When prescribed for ache, the preliminary dose is usually low (typically decrease than the beginning dose for despair). It’s progressively elevated if obligatory. Ideally, folks discover a profit inside weeks of beginning the drug, and the medicine may be continued on the lowest efficient dose. Switching to a special antidepressant could also be really helpful if ache just isn’t nicely managed, uncomfortable side effects develop, or there may be an interplay with one other medicine.

A brand new examine suggests antidepressants don’t work nicely for frequent varieties of ache

Previous analysis on antidepressants for power ache, resembling duloxetine for osteoarthritis of the knee, amitriptyline or duloxetine for power low again ache, and amitriptyline for power neck ache, demonstrated modest, short-term profit. However the research have been restricted: most trials have been small and lasted only some months or much less. Notably, medicine uncomfortable side effects, resembling nausea, constipation, and erectile dysfunction, have been frequent in these trials.

Now a 2021 examine has mixed the info from previous analysis to get a greater sense of simply how protected and efficient antidepressants are for these circumstances. The information isn’t good:

• On common, remedy with antidepressants minimally decreased ache and incapacity in contrast with placebo. The development in ache — about four factors on a scale of zero to 100 — was thought of too small to be noticeable.
• Individuals handled with sure antidepressants for power ache typically stopped taking the medicine as a result of it didn’t work, triggered unacceptable uncomfortable side effects, or each.
• Individuals with each power ache and despair didn’t expertise extra enchancment than folks with power ache alone.

Sciatica could also be an exception: antidepressants could have decreased ache for as much as a yr. Nonetheless, the standard of the prior analysis was poor, so the examine authors weren’t assured about these conclusions.

These findings solid doubt on the usefulness of antidepressant remedy for these frequent causes of power ache. Nonetheless, they don’t rule out the chance that some people could get extra reduction from these medicines than others.

The underside line

The obtainable proof means that, on common, the advantage of antidepressants for osteoarthritis or power low again ache and neck ache is modest at finest, and tends to be short-term. That’s disappointing as a result of, for a lot of ache victims, there aren’t any reliably efficient therapies (in need of joint alternative for osteoarthritis).

So, in the event you’re on an antidepressant for ache and also you aren’t positive if it’s working, discuss to your physician about whether or not it is best to contemplate stopping it. However don’t cease it by yourself. There could also be different causes your physician is recommending this medicine, and lots of antidepressants ought to be progressively decreased, not stopped suddenly, to keep away from discontinuation signs.

In case you’re taking an antidepressant for ache, it’s value revisiting whether or not it’s actually doing something for you and whether or not it could be time to shorten your medicine listing. Not solely may you simplify your medical routine, you might also scale back the price of your medicines and the chance of medication-related uncomfortable side effects.

Observe me on Twitter @RobShmerling

The publish Are antidepressants additionally ache relievers? appeared first on Harvard Well being Weblog.

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