Antidepressant treatment of fibromyalgia. A meta-analysis and review

Psychosomatics. Mar-Apr 2000;41(2):104-13. doi: 10.1176/appi.psy.41.2.104.

Abstract

Fibromyalgia is a common musculoskeletal pain disorder associated with mood disorders. Antidepressants, particularly tricyclics, are commonly recommended treatments. Randomized, controlled trials of antidepressants for treatment of fibromyalgia were reviewed by methodology, results, and potential predictors of response. Twenty-one controlled trials, 16 involving tricyclic agents, were identified; 9 of these 16 studies were suitable for meta-analysis. Effect sizes were calculated for measurements of physician and patient overall assessment, pain, stiffness, tenderness, fatigue, and sleep quality. Compared with placebo, tricyclic agents were associated with effect sizes that were substantially larger than zero for all measurements. The largest improvement was associated with measures of sleep quality; the most modest improvement was found in measures of stiffness and tenderness. Further studies are needed utilizing randomized, double-blind, placebo-controlled, parallel designs with antidepressants administered at therapeutic dose ranges, using standardized criteria for fibromyalgia and systematically assessed for co-occurring psychiatric illness.

Publication types

  • Meta-Analysis

MeSH terms

  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / therapeutic use*
  • Antidepressive Agents, Tricyclic / adverse effects
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Clinical Trials as Topic
  • Depressive Disorder / drug therapy
  • Depressive Disorder / psychology
  • Fibromyalgia / drug therapy*
  • Fibromyalgia / psychology
  • Humans
  • Serotonin Uptake Inhibitors / adverse effects
  • Serotonin Uptake Inhibitors / therapeutic use
  • Sick Role
  • Treatment Outcome

Substances

  • Antidepressive Agents
  • Antidepressive Agents, Tricyclic
  • Serotonin Uptake Inhibitors