Fibromyalgia is a chronic pain disease characterized by fatigue, poor sleep, and achiness and stiffness in ligaments, muscles and tendons. Many patients with fibromyalgia experience anxiety and depression due to chronic pain, and suffer stress symptoms such as migraines or irritable bowel syndrome. Fibromyalgia symptoms can be managed with antidepressant treatment, and there are many classes of antidepressants to choose from.
Tricyclic Antidepressants, or TCAs
TCAs include the drugs desipramine, or Norpramin, imipramine, orTofranil, cyclobenzaprine, or Flexeril, and amitriptyline, or Elavil. The TCAs Elavil and Flexeril have been shown in numerous studies to be effective at treating fibromyalgia. Tricyclic antidepressants work by inhibiting reuptake of the neurotransmitters serotonin and norepinephrine back into the brain cells. This prolongs the time the neurotransmitters are signaling. Side effects of TCAs include dry mouth, constipation, reduced ability to tear, rashes, jaundice, sexual dysfunction, daytime sleepiness and infrequent urination.
Selective Serotonin Reuptake Inhibitors, or SSRIs
SSRIs include paroxetine, or Paxil, citalopram, or Celexa, fluoxetine, or Prozac, fluvoxamine, or Luvox, sertraline, or Zoloft, and escitalopram, or Lexapro. SSRIs work by inhibiting the reuptake of serotonin back into the brain cells. SSRIs are especially effective for treating fatigue symptoms in fibromyalgia patients compared to other antidepressants. Side effects of SSRIs include sexual dysfunction, nausea, diarrhea, weight gain, forgetfulness, easy bruising and blunting of emotions.
Serotonin and Norepinephrine Reuptake Inhibitors, or SNRIs
SNRIs include venlafaxine, or Effexor, duloxetine, or Cymbalta, desvenlafaxine, or Pristiq, and milnacipran, or Ixel. SNRIs work by inhibiting the reuptake of serotonin and norepinephrine back into the brain cells. Both Cymbalta and Effexor have been found in clinical trials to be effective in treating fibromyalgia symptoms in patients that also were depressed. SNRI side effects include dry mouth, insomnia, headache, nausea, constipation and fatigue.
References
- The Merck Manual: Fibromyalgia
- "Fibromyalgia: The Complete Guide from Medical Experts and Patients"; Sharon Ostalecki; 2008.
- "Fibromyalgia: A Leading Expert's Guide to Understanding and Getting Relief From the Pain That Won't Go Away"; Don L. Goldenberg; 2002.
- The Merck Manual: Drugs Used to Treat Depression
