Chronic pain often is associated with emotional havoc, which interferes with the improvement of pain. Antidepressant medications have been shown to have success with the treatment of chronic pain. In addition, these medications have the added benefit of improved mood, improved sleep cycles and decreased anxiety. Antidepressants are drugs that can treat pain and/or emotional conditions by adjusting levels of neurotransmitters (natural chemicals) in the brain. They can increase the availability of the body’s signals for well-being and relaxation, enabling pain control for people with chronic pain conditions that do not completely respond to the usual treatments.
Although several categories of antidepressants exist, the tricyclic antidepressants are most commonly used for the treatment of chronic pain. In low doses, these medicines are effective at relieving pain, while higher doses have a more typical antidepressant effect. Amitriptyline (Elavil) is the antidepressant most commonly prescribed from this group, simply because it has been studied the most thoroughly. Other tricyclic antidepressants used for pain control include: Imipramine (Tofranil), Nortriptyline (Pamelor) and Desipramine (Norpramin). Tricyclic antidepressants seem to work best for the burning or searing pain common after nerve damage, which sometimes occurs with diabetes, shingles or strokes. These drugs are also effective in some people for Fibromyalgia, or as a preventative for migraine headaches. Tricyclic antidepressants don’t cause dependence or addiction, and they are safe to take for long periods of time. But they can make you drowsy. In addition, these drugs may cause dry mouth, constipation, weight gain, difficulty with urination and changes in blood pressure. To reduce or prevent side effects, your doctor will likely start you at a low dose and slowly increase the amount. Most people are able to take tricyclic antidepressants, particularly in low doses, with only mild side effects. The doses that are effective for pain are typically lower than the doses used for depression.
Two newer forms of antidepressants, selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), have fewer side effects than tricyclic antidepressants and are sometimes used to treat chronic pain.
Selective Serotonin Reuptake Inhibitors (SSRIs):
SSRIs include such drugs as paroxetine (Paxil) and fluoxetine (Prozac). People who have chronic pain may feel better while taking SSRIs, but this effect is believed to result more from the easing of accompanying depressive symptoms rather than from actual pain relief.
Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs):
Drugs such as venlafaxine (Effexor) and duloxetine (Cymbalta) are SNRIs, which appear to be more effective than SSRIs at pain control, particularly neuropathic pain
caused by damaged nerves. Cymbalta has an FDA indication for treating diabetic peripheral neuropathy. SSRIs and SNRIs are known to have fewer side effects than the tricyclic antidepressants, and therefore, may be better treatment options for chronic neuropathic pain.