Fibromyalgia has no known cause or cure and can be difficult to diagnose. Research into this painful disease is constantly providing more clues [1] to both etiology and treatment, and many doctors are becoming more aware of what was once considered an "invisible disease [2]." Fibromyalgia syndrome (FMS) is characterized by chronic widespread pain, tender spots on the body, fatigue, and sleep difficulties. Some patients are affected so severely that they must give up most daily activities and live as invalids.
An analysis of previous studies to evaluate the effects of fibromyalgia treatment with antidepressants was conducted by Winfried Hauser, M.D., of Klinikum Saarbrucken, Saarbrucken, Germany. Eighteen randomized controlled trials, involving 1,427 individuals were included in the study. In North America and Europe there is an estimated 6 percent of the population affected by the disease. Though the percentage sounds small, that amounts to about 5 million Americans. The public health costs related to the treatment of these patients, directly and indirectly, is very high, so finding options to help those affected benefits all.
Antidepressants evaluated in the 18 studies included tricyclic and tetracyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs). The findings indicate that TCAs, which are older generic drugs, were more effective in reducing pain. Newer antidepressants such as SSRIs were not as effective, though all of the antidepressants helped to relieved depression in patients who were depressed. Not enough data is available to make long-term recommendations for the use of any of the antidepressants according to the authors. The study did not include Lyrica, marketed by Pfizer, Inc. as a treatment specific to the disease and recently approved for the condition.
Daniel Clauw, a professor of medicine at the University of Michigan who studies fibromyalgia, but was not involved in this study, said that the drugs were not acting solely as antidepressants, but that if you treat the depression you also treat the pain. According to Clauw the SSRIs don’t produce pain relief as they do not affect one of the brain chemicals involved. Included SSRIs were Lilly’s Prozac, Pfizer’s Zoloft, Forest Laboratories Celexa, and GlaxoSmithKline’s Paxil.
The authors stress that before any treatment is initiated any other disease the patients have must also be evaluated for the potential of adverse effects of the drugs. There is no evidence for the long-term treatment of FMS with antidepressants so the effect on the patient should be re-evaluated at regular intervals to determine if they are still effective for the patient and if benefits outweigh adverse effects.
What benefits one patient will not be helpful to another and as this study and others indicate the search for relief for those who suffer from FMS may take time and their own analysis of results.