Antidepressants for fibromyalgia
Clinical bottom line
Antidepressants work well in a minority of persons with fibromyalgia, but the evidence for this has not been clearly laid out.
Reference
Uçeyler et al. A systematic review on the effectiveness of treatment with antidepressants in fibromyalgia syndrome. Arthritis Rheum. 2008 59:1279-1298.
Study
- Date review completed: October 2007
- Number of trials included: 26
- Number of patients: not calculated
- Control group: placebo
- Main outcomes: pain, fatigue, sleep, depression, quality of life
Results
The methodological quality of the 26 trials was mixed, with at least half having good scores. Outcome reporting was varied, as was duration, which was about 13 weeks at longest.
Amitrityline (10-100 mg) was assessed in 13 of the trials. Most showed reduction in pain and fatigue, and improved sleep.
Nortripyline was ineffective in one trial.
SSRIs were used in 12 studies. Most showed reduction in pain, some in fatigue, with most indicating improved sleep. Studies showed citalopram to be no better than placebo based on two very small, short duration studies. .
Comment
That's about as much as can be said from this systematic review, which essentially did no more than vote count, irrespective of quality, or size, or validity. It is entirely possible that this overstates the position with antidepressants, which clearly work well in a minority of persons with fibromyalgia. This is the latest of a series of systematic reviews of similar nature, none of which makes particularly edifying reading.