The role of antidepressants in fibromyalgia
DOI:
https://doi.org/10.32385/rpmgf.v26i1.10708Keywords:
Fibromyalgia, Antidepressants, Fibromyalgia TreatmentAbstract
Introduction: Fibromyalgia is characterized by chronic widespread pain of unknown etiology associated with fatigue, stiffness, sleep disturbance, depression, anxiety, headache, migraine, variable bowel habits, abdominal pain and urinary frequency. The 1990 American College of Rheumatology criteria for fibromyalgia include widespread pain and the presence of excessive tenderness on applying pressure to 11 of 18 specific muscle-tendon sites. Its prevalence is 2% in the United States. Objective: Review of recent evidence on the role of antidepressants in fibromyalgia. Data sources: Medline/PubMed and eviden ce-based medicine sites. Review methods: Research of meta-analyses (MA) and systematic reviews (SR) published between 2000 and July 2008, in Portuguese and English, using the key-words Fibromyalgia, Antidepressants, Fibromyalgia Treatment. The SORT taxonomy was used to present the results. Results: From the 10 articles found, 3 MA and 4 SR were selected. Analysis showed that the effect of tricyclic an tidepressants in fibromyalgia is moderate, being higher in sleep and reduced in pain and stiffness. The cyclobenzaprine, which has a similar tricyclic structure to amitriptyline, although it performs as a muscle relaxant and not as an antidepressant, improves global functi on of patients, sleep, and less significantly, the pain. Regarding serotonin and norepinehrine reup take in hibitors, the milnacipram and duloxetine are effective in pain and quality of life, while even lafaxine seem to be effective in higher doses. Of the serotonin reup take inhibitors, fluoxetine is effective in pain, well being and depression, paroxetine reduces the impact of the disease on the quality of life, with no effect on pain and citalopram is ineffective. Regarding monoamineoxidase inhibitors, the pirlindol improves pain and well being of patients, while moclobemide is ineffective. Conclusions:The antidepressants with proven benefit in treating fibromyalgia are amitriptyline, duloxetine, milnacipram (SORT A), fluoxetine and pirlindol (SORT B). Also cyclobenzaprine proved efficacy in treating fibromyalgia (SORT A). Long duration studies are needed to determine their benefit in the long term.Downloads
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