Fibromyalgia and the Nature of Pain Itself: Part 5, Antidepressants

By | August 10, 2011

Antidepressants are a widely varied group of drugs that among other actions appear to modulate and help reduce pain.

While narcotics seem to have no role in the treatment of fibromyalgia, antidepressants seem to be uniquely effective. Even more striking is the effect produced when a tricyclic antidepressant is combined with an SSRI or an SNRI. This synergistic effect suggests that these two groups of drugs are targeting different receptor subgroups or processes. If the physiological basis for this synergy can be delineated, it is likely that new drugs or combinations can be found that will produce greater positive effects with a lower incidence of side effects.

In addition, the importance of norepinephrine in these processes can be highlighted by the fact that at least with regard to pain the serotonin norepinephrine reuptake inhibitors seem to be more effective than the selective serotonin reuptake inhibitors. Unfortunately they also seem to have a higher incidence of dysphoric and excitatory side effects.

Moreover the effectiveness of this combination of tricyclic antidepressants and selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors is not limited to fibromyalgia. I have noted excellent responses in certain cases of cervicogenic headaches who are waiting for or who have been denied stimulator trials as well as certain neuropathic pain states. This suggests that norepinephrine and serotonin are involved in a variety of pain signaling processes. The trick will be to analyze receptor subtypes in different patients and in different parts of the nervous system to see if more effective and more specific drugs or therapies can be designed for a variety of chronic pain conditions.

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