Antidepressants and Fibromyalgia



Depression is a common fibromyalgia symptom. But who wouldn’t be depressed by having to deal with many days each month when you’re completely exhausted and in pain? A lot of doctors focus on the depression aspect of fibromyalgia, and a lot of fibro sufferers are understandably wary when they get a prescription for antidepressants because it feels like another variation of being told “it’s all in your head.” Here’s the real deal about antidepressants and fibromyalgia.

Antidepressants Have Come a Long Way

One antidepressant in particular, Cymbalta, received FDA approval specifically for treating fibromyalgia. It’s only the second drug that was approved for treating fibro. The other approved medication is Lyrica, which is not an antidepressant. Lyrica is in the anticonvulsant category of drugs but appears to work on the pain centers in the brain.

Different Results from Different Medications

Some antidepressants help fibromyalgia patients with symptoms other than depression. One study of fibromyalgia patients found that low doses of a tricyclic antidepressant called amitriptyline provided the greatest relief from pain, fatigue and sleep disturbances. However, it did not appear to have much of an impact on depression itself.

Cymbalta is a serotonin-norepinephrine reuptake inhibitor (SNRI), one of the newest classes of antidepressants. Because it is specifically approved for fibromyalgia, this is the antidepressant you may be prescribed first. The same study showed that Cymbalta provided a small amount of relief from pain, fatigue and sleep disturbances.

Prozac and Paxil are both selective-serotonin re-uptake inhibitors (SSRI) medications that are the “gold standard” medications used for treating patients with depression. The study showed that these drugs had a minor effect on depression and pain, but showed no benefit for sleep or fatigue.

Certain Antidepressants Can Make Some Symptoms Worse

Sexual dysfunction is a common problem for fibro sufferers. Many women with fibromyalgia find it difficult to reach orgasm. Taking antidepressants can make this problem worse. Sexual dysfunction is a known side effect of certain antidepressants, particularly those in the SSRI category like Prozac and Zoloft.

Fibromyalgia as Mind-Body Illness

We know for certain that fibro symptoms are not all in your head. We also know that depression doesn’t cause fibromyalgia symptoms, either. However, it is clear that there is a definite mind-body link in fibromyalgia. Most fibro sufferers will tell you that stressful life events are likely to trigger a flare-up of symptoms. It is also probable that the pain of a fibro flare causes anxiety, and the isolation that often comes from having to stay home while in pain can lead to depression.

Depression is common in people who suffer from other chronic pain conditions as well, such as chronic back pain or multiple sclerosis. There seems to be a cyclic relationship between pain and depression. Those who are in pain are more likely to hide and to feel upset about their loss of normal activity, which leads to depression. Many of the symptoms of depression are self-perpetuating and lead to more depression.

Using antidepressants to break the cycle between pain and depression may work for some people, but it’s not always a magic fix. Regardless of whether or not you choose to take antidepressants, make sure to see friends and family, get regular gentle exercise and take care of yourself. You’re worth it!