Can antidepressants help treat fibromyalgia if you’re not depressed?

A. Fibromyalgia is a disorder characterized by pain in the muscles and joints; the pain often feels like a dull ache that is widespread throughout the body. People with fibromyalgia feel pain in response to stimuli that don’t normally hurt - for instance, certain parts of the body feel tender in response to pressure. Other symptoms include fatigue, sleep disturbances, and problems with mood and memory.

Of the three FDA-approved drugs for fibromyalgia, two are antidepressants: duloxetine (Cymbalta) and milnacipran (Savella). Laurence Bradley, professor of medicine in the division of clinical immunology and rheumatology at University of Alabama at Birmingham, explains that both of these drugs work by influencing the availability of two chemicals in the brain - serotonin and norepinephrine - that are involved in depression and pain.

The relationship between depression and pain is complicated. Bodily pain, including headache and backache, is a common symptom of depression. And depression is common in people with conditions like fibromyalgia. “There’s a good deal of overlap between depression and fibromyalgia, and between depression and other disorders that are characterized by a high level of pain sensitivity, like irritable bowel syndrome,’’ Bradley says. But not everyone who has fibromyalgia experiences depression, and evidence suggests that the two approved antidepressants can alleviate symptoms in fibromyalgia patients regardless of whether they are depressed.

The other approved fibromyalgia drug is pregabalin (Lyrica), an anti-seizure medication found to be effective in treating pain disorders. Doctors also sometimes prescribe other antidepressants, analgesics (pain reducers), and anti-seizure medications to treat fibromyalgia. Bradley says that while these treatments can be helpful, they’re usually not enough. Patients need additional help, including cognitive behavioral therapy to deal with pain, and adopting strategies to minimize pain in daily activities. Exercise therapy also helps.

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