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By Alan Mozes
NEW YORK, Mar 19 (Reuters Health) - Antidepressant drugs can help some people with fibromyalgia, an analysis of recent studies has found, but it remains impossible to tell whether this effect is due to relief of depression alone or if the drugs help treat fibromyalgia itself.
Fibromyalgia is a chronic condition, often accompanied by depression and fatigue, in which a person feels pain in the muscles and tissues surrounding the joints. Nine in 10 fibromyalgia patients are female. While the cause of fibromyalgia is unknown, researchers have found pain-processing abnormalities in the spines and brain stems of those with fibromyalgia.
Antidepressant drugs relieve pain, fatigue and insomnia in 25% of people with fibromyalgia who take them, according to an analysis of 10 studies by P. G. O'Malley and colleagues published in the Journal of General Internal Medicine. The study is reprinted in The Journal of Family Practice with a commentary by Dr. James G. Slawson of the Medical College of Wisconsin in Milwaukee.
"The bottom line is antidepressants are worth trying," Slawson told Reuters Health. "The results are not bad for the hard-to-treat condition of fibromyalgia...however, we have no information on how long any benefit would last."
A person is diagnosed with fibromyalgia if he or she has tenderness in at least 11 of 18 specific trigger points, including the hip, elbow, knee, the neck at the base of the skull and midway between the neck and shoulder. In the analysis, no effect of antidepressants on pain at patients' trigger points was seen.
In an interview with Reuters Health, Slawson concurred with the study's authors that it is impossible to determine whether the medication's effect on symptoms has anything to do with its effect on depression. "If a patient with fibromyalgia is depressed, treating the depression would help them feel better even if it did not treat the fibromyalgia," he noted. Slawson also suggested that much more research is needed to look into which antidepressants would have the most benefit, and how long those benefits might last.
The findings are similar to research on exercise for treating fibromyalgia. Although exercise--along with medication and psychotherapy--is part of the standard treatment for this condition, and does help reduce overall pain, fatigue and depression, it does not change trigger-point sensitivity.
SOURCE: Journal of General Intern Medicine 2000;15:659-666; The Journal of Family Practice 2001;50:14.
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