Do Antidepressants Improve Pain Symptoms in Depressed Patients?
A meta-analysis published in the Journal of Clinical Psychopharmacology found a positive correlation between antidepressant treatment effects and pain relief.
Patients with depressive disorders commonly experience pain, but data is lacking on the effects of antidepressants on pain symptoms, particularly tricyclic/tetracyclic antidepressants (TCAs), as these agents have been previously excluded from existing meta-analyses.
Stefan Gebhardt, MD, and coauthors conducted a broad, systematic literature search on antidepressant treatment in patients with depressive disorders and comorbid pain symptoms. They then conducted a random-effects meta-analysis among three different drug groups for pain and depression endpoints. The authors identified 14 placebo-controlled studies with selective serotonin-noradrenaline reuptake inhibitors (SSNRIs) with three of these studies also evaluating selective serotonin reuptake inhibitors (SSRIs). An additional three placebo-controlled SSRI studies were identified whereas only two placebo-controlled studies on TCAs were identified.
Data from the analysis showed that SSNRIs and SSRIs were significantly superior vs. placebo in regards to analgesic effects. All effects were small, however, noted study authors. A strong positive correlation between pain relief efficacy and positive effect on mood was observed for SSNRIs but this relationship refers to patients with primary depressive disorders and not to patients with primary pain disorders.
Dr. Gebhardt explained, "The analgesic effects of SSNRIs and SSRIs in patients with primary depressive disorders can be interpreted as largely equivalent." Due to a lack of placebo-controlled studies on TCAs, "the results for TCAs would be comparable only to those of SSRIs and SSNRIs if non-placebo-controlled TCA studies were included." More studies are needed to compare the effects of various antidepressants on pain in patients with depressive disorders.
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