The selective serotonin reuptake inhibitor paroxetine is effective in the treatment of diabetic neuropathy symptoms

Abstract

The effect of the selective serotonin reuptake inhibitor paroxetine on diabetic neuropathy symptoms was examined in comparison to imipramine and placebo in a randomised, double-blind, cross-over study. Paroxetine was given as a fixed dose of 40 mg/day, while the dose of imipramine was adjusted to yield optimal plasma levels of imipramine plus desipramine of 400-600 nM. Paroxetine significantly reduced the symptoms of neuropathy as measured by both observer- and self-rating, but was somewhat less effective than imipramine. However, patients showing a weaker response to paroxetine than to imipramine had lower plasma concentrations of paroxetine than patients with similar response to the 2 drugs. On imipramine 5 patients dropped out because of intolerable side effects and 4 of 19 patients completing the study reported withdrawal symptoms after discontinuing imipramine. On paroxetine no patients dropped out due to side effects and no withdrawal symptoms were reported. Self-rating showed no depressive symptoms at baseline, and no changes during the study. Neither paroxetine nor imipramine caused changes in objective measures of peripheral nerve function. In conclusion, 40 mg paroxetine/day significantly reduced the symptoms in peripheral diabetic neuropathy, and it was suggested that by dose adjustment on the basis of drug level monitoring, paroxetine may become as effective as imipramine. Paroxetine was devoid of the often disturbing autonomic side effects limiting the use of imipramine in several patients.

Low dose amitriptyline in the treatment of chronic pain

“…This benefit occurred within the first week (Fig. 2), as has been found in another antidepressant pain study [4], but not in all [3,101. The benefit was shown compared with both placebo and baseline.…”

The Efficacy of Selective Serotonin Reuptake Inhibitors for the Management of Chronic Pain

“…14 In the treatment of painful diabetic neuropathy, Sindrup et al found improvement in patients treated with paroxetine who either were not depressed or did not experience an antidepressant effect as measured by the Beck Depression Inventory. 17,18 In contrast, Max et al found that fluoxetine was more effective than placebo only in the subgroup of depressed patients. 16 In fibromyalgia, Goldenberg et al found improvement in the fluoxetine group despite no change in their Beck Depression Inventories.…”

“…Sindrup et al found that imipramine relieved diabetic neuropathy more effectively than paroxetine. 17 Max and colleagues found a significant improvement in diabetic neuropathy with amitriptyline and desipramine, but not with fluoxetine. 16 Bendtsen et al found improvement in tension-type headache with amitriptyline, but not citalopram.…”

Effects of methylene blue on postoperative low-back pain and functional outcomes after lumbar open discectomy: a triple-blind, randomized placebo-controlled trial

“…2,26 In fact, only a few SSRIs proved effective for neuropathic pain in clinical trials. 45,46 After nerve injury, the 5-HT content in the lesioned nerve increases. 5-HT receptors of the 5-HT3 and 5-HT2A subtype are present on C-fibers.…”