Antidepressant use in painful rheumatic conditions.
This article reviews the pharmacologic and clinical evidence supporting the use of antidepressant drugs for treating painful rheumatologic conditions. Clinical studies have shown that tricyclic antidepressants, even at low doses, have analgesic effects in rheumatologic conditions equivalent to those of serotonin and noradrenalin reuptake inhibitors, but are less well tolerated. Selective serotonin reuptake inhibitors may also have analgesic effects, but higher doses are required to achieve analgesia in conditions such as fibromyalgia and low back pain. Antidepressant drugs may be useful in painful rheumatologic conditions, but in some studies the analgesic effects of antidepressants may be associated with functional impairment, sleep disorders, and fatigue. Further studies are required to determine antidepressants' analgesic mechanism of action and the specific role they should play in the management of chronic painful rheumatologic conditions.
Perrot
Serge
S
Service de Médecine Interne et Thérapeutique, Consultation de la Douleur, Hôtel Dieu, Université Paris Descartes, 1 Place du Parvis Notre Dame, 75004 Paris, France.
Javier
Rose-Marie
RM
Marty
Marc
M
Le Jeunne
Claire
C
Laroche
Françoise
F
D000700:Analgesics / Q000494:pharmacology; D000928:Antidepressive Agents / Q000494:pharmacology*; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012216:Rheumatic Diseases / Q000150:complications* / Q000188:drug therapy
D000700:Analgesics; D000928:Antidepressive Agents