Fibromyalgia treatment: Antidepressants reduce pain, not just depression

by James Hubbard, M.D., M.P.H.

Everything old is new again.

Want to know the best fibromyalgia medicine?  Look back to the future.  Lyrica, Neurontin, Cymbalta?  Think cheaper.  It’s the one I’ve been prescribing for years for chronic pain. A recent study shows it works as well as, or better than, the newfangled ones.

Investigators in the latest Journal of the American Medical Association evaluated all the past studies on antidepressant treatment for fibromyalgia and found they do help–and not just for the depression symptoms.

Fibromyalgia is a syndrome composed of symptoms like muscle aches, fatigue and sleep disturbance.  It can be disabling and difficult to treat.

Antidepressants substantially abate pain, fatigue and sleep disturbances and improve the vague but important “quality of life.”  But not just any antidepressant will do.  The investigators found the old-as-I-am tricyclic antidepressants, such as amitriptyline (Elavil), work best.

Tricyclics have always been effective against depression, but the dosage needed (100 to 150 mg) can cause side effects like drowsiness and dry mouth.I’ve prescribed it forever to treat pain syndromes such as chronic tension headaches, and to help induce sleep, but always at a lesser dosage than needed to treat depression.  The JAMA study agrees.  They used 12.5 mg. to 50 mg daily.

The much newer antidepressant duloxetine (Cymbalta) worked pretty well and is FDA-approved to treat fibromyalgia.

Fibromyalgia patients, if you haven’t tried low-dose amitriptyline, why not ask your doctor about it?  No, we’re not trying to fool you by thinking all your symptoms are from depression, and this study proves it.  If you do try it, give it a few weeks to get the full effect.

Remember, though, this blog is for information only and never for specific treatment.  Always talk over your particular situation with your doctor.

The cause of fibromyalgia syndrome is unknown, and we need better tests for diagnosis.  See my blog on a new objective test being studied that may lead to a more accurate diagnosis. Just as we’re not sure what causes fibromyalgia, we’re not sure why antidepressants help with the pain.

What do you think?  Ever tried it?  Does it help?

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8 Responses to “Fibromyalgia treatment: Antidepressants reduce pain, not just depression”

  1. Relevant posts | Bipolar Syndrome, Bipolar Information, Signs of Bipolar and Bipolar Condition Says:

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  2. Dr. J Says:

    I do not have any experience with this, but anytime we can use a drug which minimizes the side effects while maximizing the desired effect it’s a good thing! Thank you for this information, Dr. Hubbard!

    Dr. Js last blog post..Nibbles: More Americans obese than overweight, peanut butter may be cause of salmonella outbreak and stats on vegetarian kids

  3. James Hubbard, M.D., M.P.H. Says:

    Thanks Dr. J

    Also it is a cheap generic.

  4. James Hubbard’s My Family Doctor Blog » Blog Archive » Lyrica and fibromyalgia: Why does a medicine for nerve pain help a muscle disease? Says:

    [...] recently wrote about a JAMA study that showed how well the antidepressant amitriptyline worked for fibromyalgia symptoms, though we [...]

  5. » Fighting Fatigue CFS & Fibromyalgia Blog Carnival #7 Says:

    [...] Hubbard, M.D., M.P.H. presents James Hubbard’s My Family Doctor Blog » Blog Archive » Fibromyalgia treatment: Antidepressants r… posted at James Hubbard’s My Family Doctor [...]

  6. James Hubbard, M.D., M.P.H. Says:

    Hi woohoo.
    Thanks for the comments and sharing your experience.
    If your doctor suggests Cymbalta, please know it is NOT the same type of drug as amitripyline. Both treat depression, but Cymbalta is a selective seratonin and norepinephrine reuptake inhibitor (SSNRI). It has a different mechanism of action (way of working.

  7. Teresa Says:

    I have a diagnose of FMS since 1995. Since then I have try every “new” drug/vitamins suggested for FMS and I always go back to Amitriptyline. My regular dose is 25mg at night no matter how I feel, then if I get more pain/spams/sleep difficulty/depression or some of the symtomps I increase the dosis to 25mg around 7:00PM and a second 25mg pill around 10:00PM.
    2 weeks ago a new Reumatologist asked me to stop taking the amitriptyline and prescrive Savella. I did as told for 10 days but I got headaches, dizziness, I could not sleep so I stop taking the Savella and went back to the Amitriptyline adding 10mg AM. to see if this can help me with a mild depression.
    Should I keep taking amitriptyline in the mornigs or will you suggest something else?
    I tried Cymbalta once but I have sexual dysfunction as a side effect that I do not have with Amitriptilyne.

  8. John Gatesby Says:

    As per recent research, there could be a relation between FMS and a microbe in the gut, it is being investigated, I believe and if a relationship is established then there could be a chance of a perfect cure.

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