Tricyclic antidepressants for fibromyalgia

Examples

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Brand Name	Generic Name
Elavil	amitriptyline hydrochloride

Brand Name	Generic Name
Sinequan	doxepin hydrochloride

Brand Name	Generic Name
Tofranil	imipramine hydrochloride

Brand Name	Generic Name
Pamelor	nortriptyline

Brand Name	Generic Name
Desyrel	trazodone

How It Works

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Experts do not know exactly how tricyclic antidepressants improve symptoms of fibromyalgia. They may help some people with fibromyalgia to sleep better through the night by increasing the deep phase of sleep and decreasing muscle spasms.¹

These medicines can also be used to treat depression.

Why It Is Used

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Doctors may prescribe tricyclic antidepressants when sleep problems are a major symptom of fibromyalgia.

How Well It Works

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Some research indicates that tricyclics may be more effective than other antidepressants for treating fibromyalgia symptoms.² They are good at helping with sleep problems, but they may become less effective over time.^{1 3}

Side Effects

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Side effects vary among the different medicines of this type. They may include:

• Drowsiness.
• Dry mouth.
• Constipation.
• Difficulty urinating.
• Confusion.
• Agitation or nightmares.
• Lightheadedness when a person stands up too quickly (caused by lowered blood pressure).
• Fast heart rate.

People who have seizures (epilepsy), difficulty urinating (urinary retention), glaucoma (an eye disease), or heart conditions may notice that tricyclic antidepressants make these symptoms worse.

FDA Advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Studies suggest that using the combination of a tricyclic antidepressant and a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine hydrochloride (Prozac), may be more successful at breaking the cycle of pain and sleep problems caused by fibromyalgia than using just a single medicine.

These medicines may take 1 to 3 weeks to start to work. They usually work quickly to improve sleep but may take several weeks to improve pain—up to 6 to 8 weeks in older adults. Treatment with antidepressants does not always relieve symptoms caused by fibromyalgia. Even when the treatment does work, some people may find the side effects of these medicines unacceptable.

Using an antidepressant medicine to treat fibromyalgia does not mean that the condition is "all in your head." The dose of a tricyclic antidepressant used to treat fibromyalgia is usually much less than that needed to treat depression.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Bradley LA, Alarcon GS (2005). Fibromyalgia section of Miscellaneous rheumatic diseases. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 1869–1910. Philadelphia: Lippincott Williams and Wilkins.

2. Goldenberg DL, et al. (2004). Management of fibromyalgia syndrome. JAMA, 292(19): 2388–2395.

3. Arnold LM (2000). Antidepressant treatment of fibromyalgia. Psychosomatics, 41(2): 104–113.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Tracy Landauer
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Stanford M. Shoor, MD - Rheumatology
Last Updated	October 30, 2007