Antidepressants in Pain Treatment: Antidepressant or Analgesic Effect?

Guidelines for the use of antidepressants in painful rheumatic conditions

“…Side effects parallel TCAs analgesic effects and, in most cases, depend on dose (McQuay et al, 1996). Rapid wash‐out may lead to severe symptoms, such as nausea, vomiting, and trembling (Sindrup et al, 1992). Before starting TCA treatments, the physician should check for orthostatic hypotension and perform an ECG.…”

“…Side effects are reported in up to 80% of patients treated for painful conditions (Bird and Broggini, 2000;Norregard et al, 1995;Wolfe et al, 1994) but are clinically relevant in a lower proportion (0-41%) (Jung et al, 1997). This may account for the lower rate of treatment drop-outs with SSRIs than with TCAs (Bird and Broggini, 2000;Sindrup et al, 1992;Usha Rani et al, 1996) in pain studies. In fibromyalgia, SSRIs are well tolerated, about as well as placebo (Cantini et al, 1994;Norregard et al, 1995;Wolfe et al, 1994), and are therefore more readily prescribed.…”

“…The prescription of antidepressants (Blier and Abbott, 2001;Bryson and Wilde, 1996;Eschalier et al, 1998) is increasing for many conditions, including fibromyalgia, rheumatoid arthritis, spondylarthropathies, low back pain and osteoarthritis. Although antidepressants have often been shown to reduce pain, the results obtained are variable (Barkin and Fawcett, 2000;Lynch, 2001 Van Houdenhove, 1992;Zitman et al, 1992) and many questions remain unanswered (Egbunike and Chaffe, 1990;Phillip and Fickinger, 1993;Sindrup et al, 1992). For example: Does the analgesic effect depend on the antidepressant effect?…”

Depression-like behavior and mechanical allodynia are reduced by bis selenide treatment in mice with chronic constriction injury: a comparison with fluoxetine, amitriptyline, and bupropion

“…Additionally, fluoxetine reduced the immobility time in sham animals but did not modify the depressive-like behavior in CCI animals in the FST. It has been reported that fluoxetine, commonly used to treat major depression in humans (Holtzheimer and Nemeroff 2006), is modestly active in a test of tactile allodynia and nociceptive tests (Sindrup et al 1992;Pedersen et al 2005). The SSRI employed in this study, fluoxetine, displays distinct selectivity for 5-HT neuronal uptake sites (Hyttel 1994).…”

Effects of Analgesic or Antidepressant Drugs on Pain- or Stress-Evoked Hippocampal and Spinal Neurokinin-1 Receptor and Brain-Derived Neurotrophic Factor Gene Expression in the Rat

“…However, their efficacy as adjuvant therapeutics varies with the class of antidepressant used and the type of pain condition (Watson, 1994). Analgesic effects usually occur at lower doses and with an earlier onset than antidepressant effects (Sindrup et al, 1992;Lynch, 2001). Mechanistically, antidepressants are thought to produce analgesia by increasing the activity of noradrenergic and serotonergic projections descending from the brain to the spinal cord to modulate the release of endogenous opioid peptides (Testa et al, 1987).…”