Predictors of treatment response to serotonin and noradrenaline reuptake inhibitors in fibromyalgia

Abstract

What is new?Fibromyalgia (FM) patients are heterogenous in metabolic status. Contrary to the previously published data our study shows that only a subgroup of FM patients is characterized by insulin resistance. FM patients who are responsive to SNRI (serotonin and noradrenalin reuptake inhibitors) treatment have similar levels of fasting glucose, insulin, insulin resistance, BMI compared to healthy controls. However, FM patients who are not responsive to treatment with SNRI are characterized by higher fasting glucose, fasting insulin, insulin resistance, BMI compared to healthy controls and to FM patients responsive to SNRI. FM patients who are not responsive to treatment with SNRI present higher prevalence of depression, anxiety and personality disorders than those responsive to SNRI. Insulin resistance, depression, anxiety and personality disorders are predictors of the lack of response to treatment with SNRI in fibromyalgia.

Effectiveness of Vortioxetine in Patients with Major Depressive Disorder Associated with Chronic Pain: An Observational Study in a Spanish Population

“…Discrimination between these conditions is difficult, and treating them individually is inconvenient owing to the low efficacy of this approach [ 8 ]. Although TCAs and SNRIs are the first-line treatment options for this comorbid condition [ 9 , 15 , 17 ], they have been shown to be ineffective in a significant number of patients [ 10 , 13 , 19 ]. As there is little evidence that SSRIs are useful in CP [ 21 ], new treatment alternatives are needed for this comorbidity.…”

“…Likewise, the presence of pain reduces the chance of recovery from depression and is related to more intense symptoms in these patients [ 8 ], including impaired sleep, enhanced anxiety, and impaired cognition [ 9 ]. Furthermore, in some cases, the presence of depression in patients with CP is a predictor of non-response to antidepressants [ 10 ]. Thus, this comorbidity exacerbates the symptoms of both conditions, making treatment more difficult and complicating the management of these patients.…”

“…At the same time, they have also been shown to be useful in the management of concomitant chronic and neuropathic pain [ 9 , 15 , 17 , 18 ]. However, in a significant number of patients suffering chronic or neuropathic pain, these treatments have been shown to be ineffective [ 10 , 13 , 19 ]. In addition, some patients have poor tolerability to these two drug classes so, in these cases, selective serotonin reuptake inhibitors (SSRIs) are an alternative to obtain a good antidepressant response [ 17 , 20 ].…”

Consolidating evidence on the role of insulin resistance in major depressive disorder

“…Also, we recently presented a pilot analysis exploring the links between IR and response to treatment with SNRI in MDD. The results indicated that MDD subjects resistant to SNRI were characterized by higher IR and BMI than those responsive to SNRI [28]. On the other hand, trials exploring the effectiveness of psychotherapy in adolescent girls with depression at risk of TMD2 failed to show the link between improvement of depression and IR [29].…”

“…In a study of fibromyalgia patients, of which 58% were comorbid with MDD, we found that IR, depression, anxiety and personality disorders were predictors of nonresponse to serotonin and noradrenaline reuptake inhibitors. Of interest, while subjects resistant to SNRI had significantly higher BMI than those responsive to SNRI, the relationship between BMI and resistance to SNRI was fully mediated by IR [ 27 ▪ ]. Also, we recently presented a pilot analysis exploring the links between IR and response to treatment with SNRI in MDD.…”