Treatment of fibromyalgia syndrome with antidepressants: a meta-analysis.
BACKGROUND
Fibromyalgia syndrome (FMS) is a chronic pain disorder associated with multiple debilitating symptoms and high disease-related costs. Effective treatment options are needed.


OBJECTIVE
To determine the efficacy of antidepressants in the treatment of FMS by performing a meta-analysis of randomized controlled clinical trials.


METHODS
MEDLINE, PsycINFO, Scopus, and the Cochrane Library databases were searched through August 2008. Reference sections of original studies, meta-analyses, and reviews on antidepressants in FMS were reviewed.


METHODS
Randomized placebo-controlled trials with tricyclic and tetracyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs) were analyzed.


METHODS
Two authors independently extracted data. Effects were summarized using standardized mean differences (SMDs) by a random-effects model.


RESULTS
Eighteen randomized controlled trials (median duration, 8 weeks; range, 4-28 weeks) involving 1427 participants were included. Overall, there was strong evidence for an association of antidepressants with reduction in pain (SMD, -0.43; 95% confidence interval [CI], -0.55 to -0.30), fatigue (SMD, -0.13; 95% CI, -0.26 to -0.01), depressed mood (SMD, -0.26; 95% CI, -0.39 to -0.12), and sleep disturbances (SMD, -0.32; 95% CI, -0.46 to -0.18). There was strong evidence for an association of antidepressants with improved health-related quality of life (SMD, -0.31; 95% CI, -0.42 to -0.20). Effect sizes for pain reduction were large for TCAs (SMD, -1.64; 95% CI, -2.57 to -0.71), medium for MAOIs (SMD, -0.54; 95% CI, -1.02 to -0.07), and small for SSRIs (SMD, -0.39; 95% CI, -0.77 to -0.01) and SNRIs (SMD, -0.36; 95% CI, -0.46 to -0.25).


CONCLUSIONS
Antidepressant medications are associated with improvements in pain, depression, fatigue, sleep disturbances, and health-related quality of life in patients with FMS.
Häuser
Winfried
W
Department of Internal Medicine, Klinikum Saarbrücken, Winterberg 1, D-66119 Saarbrücken, Germany. whaeuser@klinikum-saarbruecken.de
Bernardy
Kathrin
K
Uçeyler
Nurcan
N
Sommer
Claudia
C
D000928:Antidepressive Agents / Q000627:therapeutic use*; D005356:Fibromyalgia / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results
D000928:Antidepressive Agents