Depression Meds Tolerable as Pain Treatment, Despite Adverse Effects

A recent meta-analysis examining the use of antidepressants for the treatment of chronic pain provides drug-specific risk profiles that could help health care providers in determining multimodal treatment regimens and which antidepressants are best for individual patients.

Although previous research has reported on the effectiveness of antidepressants for the treatment of chronic pain, evidence of the tolerability of these drugs has been inconsistent.
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In their study, the researchers searched for articles published between 1995 and 2015 that were located on MEDLINE or the National Center for Biotechnology Information Library databases. The meta-analysis included 23 randomized placebo-controlled trials that reported on the side effects and safety of different antidepressants used to treat chronic pain.

Compared with placebo, all antidepressants except nortriptyline had a higher risk for adverse effects, and each antidepressant had a distinct risk profile of adverse effects. The most common adverse events included dry mouth, dizziness, nausea, headache, constipation, palpitations, sweating, and drowsiness.

Amitriptyline, mirtazapine, desipramine, venlafaxine, fluoxetine, and nortriptyline were found to have the highest placebo effect-adjusted risk for adverse events. In addition, desipramine was associated with the highest risk for withdrawal due to adverse effects (risk ratio 4.09, followed by milnacipran, venlafaxine, and duloxetine.

Despite the increased risk for adverse effects, the overall tolerability of antidepressant treatment in individuals receiving them for chronic pain was high.

“Based on the meta-analytic comparison of adverse effect rates between antidepressants and placebo, our study confirms tolerability of low-dose antidepressants for the treatment of chronic pain and reveals specific profiles of adverse effects that differ from those of higher doses of the same drugs applied for depression,” the researchers concluded. “These findings might be useful in multimodal treatment which takes patient comorbidities and co-medication into consideration.”

—Melissa Weiss

Reference:

Riediger C, Schuster T, Barlinn K, et al. Adverse effects of antidepressants for chronic pain: a systematic review and meta-analysis [Published online July 14, 2017]. Front Neurol. https://doi.org/10.3389/fneur.2017.00307.