Review of antidepressants in the treatment of neuropathic pain

Abstract

Introduction Neuropathy is a pathological pain disorder characterized by burning, stabbing, and cramping sensations. There are multiple etiologies for this pain such as diabetes, vascular disorders, and chemotherapy treatment. Neurotransmitters, such as norepinephrine and serotonin, are thought to play a part in the modulation of this pain. The objective of this review is to summarize the current literature to support the efficacy and impact of adverse events of the various classes of antidepressants utilized in the treatment of neuropathic pain. Methods A Medline/Pubmed search was conducted to identify randomized clinical trials within the last 12 years examining the efficacy and safety of antidepressants for the treatment of neuropathy. Systematic reviews and meta-analyses were also included. Results Antidepressants are commonly used in the treatment of neuropathy, with meta-analyses supporting the use of tricyclic antidepressants and selective norepinephrine serotonin reuptake inhibitors. Trials indicate that venlafaxine, duloxetine, and tricyclic antidepressants (TCAs) have comparable efficacy, but TCAs have a higher incidence of adverse effects. Other antidepressants, such as citalopram, paroxetine, and bupropion have limited evidence supporting their use in neuropathy. Discussion Based on the evidence reviewed, venlafaxine and duloxetine should be used as first-line agents. TCAs should be used as second-line agents, due to higher incidence of adverse effects. Other treatment options include citalopram, paroxetine, and bupropion, but data supporting their efficacy is limited.

Analysis of Antidepressant, Benzodiazepine Anxiolytic, and Hypnotic Use When Treating Depression, Anxiety, and Aggression in Pain Clinic Patients Treated for Neuropathic Pain

“…In the AD group of drugs, the efficacy in neuropathic pain management is documented for TCAs and SNRIs. At the same time SSRIs are considered less effective in neuropathic pain treatment [ 52 , 53 ].…”

How Can Drug Metabolism and Transporter Genetics Inform Psychotropic Prescribing?

“…Imipramine, the first TCA was derived from a phenothiazine, showing improvement without serious side effects in 500 patients with severe depression ( Kuhn, 1958 ; Hillhouse and Porter, 2015 ). Although TCAs are still used (e.g., second-line or with somatic symptoms) to treat depression ( Uher et al, 2009b ; American Psychiatric Association, 2010 ; Kennedy et al, 2016 ), the treatment of pain (e.g., migraine, neuropathic, cancer-associated) is now their more common therapeutic use ( Watson, 2000 ; Laird et al, 2008 ; Baltenberger et al, 2015 ).…”

Psychotropic Drugs for the Management of Chronic Pain and Itch

“…It is indicated often in medical literature that it is the class of tricyclic antidepressants (TCA) that have such efficacy. However, effective analgesic/antipruritic drugs are found among practically all antidepressant groups [12]. Anticonvulsants and antipsychotics are widely used in pain management, too [13,14].…”