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| Question: Have antidepressants provided relief for patients with chronic pain? |
Patients who experience chronic pain like arthritis or fibromyalgia are often prescribed antidepressants. What sort of cases of arthritis or fibromyalgia might show improvement with antidepressants? What are the advantages of antidepressants for them?
Answer: It is common for patients who are experiencing chronic pain like rheumatoid arthritis, lupus and fibromyalgia to also experience depression. Very often, symptoms of depression are brief and episodic. However, some patients may experience recurring and long-lasting symptoms. In these cases, it is often wise to enlist psychiatric assistance. This can be provided by a counselor, psychologist, or psychiatrist. Additionally, prescription medication may be ordered to help control the symptoms of depression.
SSRIs: Selective serotonin reuptake inhibitors are targeted at the neurotransmitter or brain chemical known as seratonin. These drugs are very often prescribed to treat depression. Among the SSRIs are:
• Prozac(fluoxetine)
• Lexapro (escitalopram)
• Celexa (citalopram)
• Zoloft (sertraline)
• Paxil (paroxetine)
• Wellbutrin (bupropion)
Most patients can deal with the moderate side effects from these effective prescriptions.
Dual Inhibitors: When an antidepressant is targeted toward two neurotransmitters, it is called a dual inhibitor. An example of two neurotransmitters that might be targeted would be serotonin and norepinephrine. This is the theory of Scott J. Zashin, M.D., who went on to explain that fatigue and pain that are associated with such conditions as fibromyalgia and chronic pain syndrome can be controlled by both types of antidepressants: SSRIs and dual inhibitors. As explained by Zashin, Cymbalta (duloxetine) and Effexor (venlafaxine), also known as dual inhibitors or dual uptake inhibitors, are what is termed SNRIs (selective serotonin and norepinephrine reuptake inhibitors).
Cymbalta is an antidepressant that may be effective in the treatment of fibromyalgia. There is a study currently underway, conducted by the maker of Cymbalta, that seeks to find out if this is true. Before the advent of SSRIs, tricyclic antidepressants were the most used treatment for depression. Elavil and amitriptyline, both tricyclic antidepressants, are often used to help insomniac patients go to sleep. These drugs can also help the patient achieve non-REM sleep, the most restorative part of the sleep cycle. In his opinion, Dr. Dr. Zashin says that fatigue and pain may be helped with tricyclic antidepressants.
There are many warnings that accompany the use of antidepressants. Because of the many side effects that accompany a dose that is high enough to treat depression, these drugs are not often used for this condition. It is important to keep an eye on adults who are taking antidepressants and are ordered to change the dosage. According to the FDA, the incidence of depression and suicidal ideation and acting out may increase within the first few months of a dosage change. They need to monitor their own behavior and report worsening depression or stronger suicidal impulses to their physicians. Potential side effects should be thoroughly outlined to patients. If any changes are noted, the patient should immediately contact his or her physician.
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