Rheumatology Advance Access originally published online on April 29, 2008
Rheumatology 2008 47(8):1117-1123; doi:10.1093/rheumatology/ken110
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Is there any evidence to support the use of anti-depressants in painful rheumatological conditions? Systematic review of pharmacological and clinical studies
1Internal Medicine Department and Pain Clinic, Hotel Dieu Hospital, Paris Descartes University, Paris, 2Rheumatology Department, Hautepierre Hospital, Strasbourg, 3Rheumatology Department, Henri Mondor Hospital, Creteil and 4Pain Clinic, St Antoine Hospital, Paris, France.
Correspondence to: S. Perrot, Service de Médecine Interne et Thérapeutique, Consultation de la Douleur, Hotel Dieu, 1 Place du Parvis Notre Dame, 7500 Paris, France. E-mail: serge.perrot{at}htd.aphp.fr; sergperrot{at}aol.com
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Abstract |
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The aim of this study was to review the evidence supporting the use of anti-depressants in painful rheumatological conditions. A systematic review of papers published between 1966 and 2007, in five European languages, on anti-depressants in rheumatological conditions was performed. Papers were scored using Jadad method and analgesic ES was calculated. We selected 78 clinical studies and 12 meta-analyses, from 140 papers. The strongest evidence of an analgesic effect of anti-depressants has been obtained for fibromyalgia. A weak analgesic effect is observed for chronic low back pain, with an efficacy level close to that of analgesics. In RA and AS, there is no analgesic effect of anti-depressants, but these drugs may help to manage fatigue and sleep disorders. There is no clear evidence of an analgesic effect inOA, but studies have poor methodological quality. Analgesic effects of anti-depressants are independent of their anti-depressant effects. Tricyclic anti-depressants (TCAs), even at low doses, have analgesic effects equivalent to those of serotonin and noradrenalin reuptake inhibitors (SNRIs), but are less well tolerated. Selective serotonin reuptake inhibitors (SSRIs) have modest analgesic effects, but higher doses are required to achieve analgesia. Anti-depressant drugs, particularly TCAs and SNRIs, have analgesic effects in chronic rheumatic painful states in which analgesics and NSAIDs are not very efficient, such as fibromyalgia and chronic low back pain. In inflammatory rheumatic diseases, anti-depressants may be useful for managing fatigue and sleep disorders. Further studies are required to compare anti-depressants with other analgesics in the management of chronic painful rheumatological conditions.
KEY WORDS: Pain, Musculoskeletal, Anti-depressants, Fibromyalgia, Low back pain, Rheumatoid arthritis, Osteoarthritis, Ankylosing spondylitis
Submitted 12 November 2007;
revised version accepted 14 February 2008.
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  J. B. Fontenele, L. K. A. M. Leal, and F. H. C. Felix Comment on: Is there any evidence to support the use of anti-depressants in painful rheumatological conditions? Systematic review of pharmacological and clinical studies & Amitriptyline in the treatment of fibromyalgia: a systematic review of its efficacy Rheumatology, March 1, 2009; 48(3): 322 - 323. [Full Text] [PDF]
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S. Perrot, R.-M. Javier, M. Marty, C. Le Jeunne, F. Laroche, and the Cercle d'Etude de la Douleur en Rhumatologie ( Comment on: Is there any evidence to support the use of anti-depressants in painful rheumatological conditions? Systematic review of pharmacological and clinical studies: reply Rheumatology, March 1, 2009; 48(3): 323 - 323. [Full Text] [PDF]
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