Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of tension-type headache in adults

Abstract

Since the last version of this review, the new included studies have not added high quality evidence to support the use of SSRIs or venlafaxine (a SNRI) as preventive drugs for tension-type headache. Over two months of treatment, SSRIs or venlafaxine are no more effective than placebo or amitriptyline in reducing headache frequency in patients with chronic tension-type headache. SSRIs seem to be less effective than tricyclic antidepressants in terms of intake of analgesic medications. Tricyclic antidepressants are associated with more adverse events; however, this did not cause a greater number of withdrawals. No reliable information is available at longer follow-up. Our conclusion is that the use of SSRIs and venlafaxine for the prevention of chronic tension-type headache is not supported by evidence.

Associations between anxiety and depression symptoms and cognitive testing and neuroimaging in type 2 diabetes

“…A total of 655 European Americans with type 2 diabetes (from 504 families) completed both measures and were included in analyses. Self-report of antianxiety (for example benzodiazepines) or antidepressant (for example SNRIs and SSRIs) medication use was adjusted for in analyses but was not considered for definition of anxiety/depression symptom groupings, as some medications could have been prescribed for either anxiety or depression symptoms or for other purposes, such as migraine headaches or insomnia (Buscemi, Vandermeer et al 2007; Banzi, Cusi et al 2015). As a supplementary analysis, CES-D and BSI Anxiety scores were analyzed as continuous measures.…”

Tension‐Type Headache – The Normal and Most Prevalent Headache

“…Thus, the noradrenergic and specific serotonergic antidepressant mirtazapine 30 mg/day reduced headache index by 34% more than placebo in difficult to treat patients, including patients who had not responded to amitriptyline . Their mechanisms of action is probably via a reduction or modification of the central sensitization, which is prominent in chronic TTH . The serotonin and noradrenaline reuptake inhibitor venlafaxine 150 mg/day reduced headache days from 15 to 12 per month .…”

“…The tricyclic antidepressant clomipramine and the tetracyclic antidepressants maprotiline and mianserin have been reported more effective than placebo, while the selective serotonin reuptake inhibitors (SSRIs) are ineffective . Interestingly, antidepressants with action on both serotonin and noradrenaline seem to be as effective as amitriptyline with the advantage that they are tolerated in lower doses than needed for the treatment of a concomitant depression . Thus, the noradrenergic and specific serotonergic antidepressant mirtazapine 30 mg/day reduced headache index by 34% more than placebo in difficult to treat patients, including patients who had not responded to amitriptyline .…”

Empirically Supported Use of Psychiatric Medications in Adolescents and Adults with IBD

“…Although meta-analyses suggest biased reporting of results with an overestimate of benefit, 113,114 aggregate data show a modest effect with an estimated 20% to 30% decrease in pain intensity rating and a number needed to treat between 7 and 11. [113][114][115][116] Despite an increasing acceptance of SNRI therapy for pain modulation, data are not consistently positive across different pain syndromes 117 and should be placed in the context of observed adverse effects. Overall, the likelihood of side effects is lower compared to TCAs, but available data place the incidence of relevant adverse events near that of subjective benefit with a number needed to harm of around 13.…”