Pain, fatigue, mood, sleep and fibromyalgia

Tricyclics work better than other antidepressants for the treatment of fibromyalgia according to new study from Germany. In a meta-analysis of 18 randomized controlled trials of antidepressants for the treatment of fibromyalgia, researchers reviewed studies utilizing tricyclic and tetracyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAO). All antidepressants were associated with a reduction in pain, fatigue, depressed mood, and sleep disturbances. Pain reduction was particularly good for tricyclic antidepressants, while MAO inhibitors showed modest effect and SSRIs and SNRIs showed a small effect. TCAs were effective in low doses of 12.5-50 mg, far below the doses commonly employed to treat depression, and were very effective for reducing pain, fatigue, and sleep disturbance (JAMA 2009;301:198-209). Currently duloxetine (Cymbalta®), pregablin (Lyrica®), and milnacipran (Savella) are the only FDA-approved drugs for the treatment of fibromyalgia.