Posted by kaleidoscope on November 9, 2007, at 11:22:42
In reply to Re: Antidepressants + Arthritis - Relief?, posted by simcha on November 9, 2007, at 2:55:53
Certain antidepressants are used to treat neuropathic pain (pain due to nerve damage) eg. post-herpetic neuralgia (chronic pain following shingles) and diabetic neuropathy. Antidepressants may possibly offer modest relief from arthritis pain but there is relatively little evidence to support this at present.
Amitriptyline (Elavil) is well established as a treatment for neuropathic pain. The usual initial dose is 10 or 25mg at night increasing to 50-75mg. Nortriptyline can be used as an alternative - starting with 10mg at night and increasing up to a usual maximum of 75mg. Nortriptyline is considerably less sedating than amitriptyline and causes a lower incidence of adverse effects overall. Other tricyclic antidepressants such as imipramine have also been used to treat neuropathic pain. There is no evidence to support doxepin or trimipramine as treatments for pain.
The SSRIs are not an effective treatment for neuropathic pain and should not be used for this purpose.
Among the newer antidepressants, venlafaxine (Effexor) and especially duloxetine (Cymbalta) can be effective in the treatment of neuropathic pain, most notably diabetic neuropathy. Duloxetine (Cymbalta) is officially approved for diabetic neuropathic pain. The usual dose is 60mg per day.
Bupropion (Wellbutrin, Zyban) might possibly be an effective treatment for neuropathic pain but evidence is very limited.
In cases of chronic non-neuropathic pain (such as arthritis), treatment with amitriptyline has been found helpful by some. Nortriptyline or duloxetine (Cymbalta) might also be helpful, and could be especially useful if amitriptyline was not tolerated. Amitriptyline may be most useful when pain is accompanied by insomnia. Nortriptyline is less sleep-inducing and causes less daytime drowsiness. Duloxetine (Cymbalta) may cause fewer side effects than amitriptyline, but is newer, expensive and less well-established.
poster:kaleidoscope
thread:793849
URL: http://www.dr-bob.org/babble/20071104/msgs/794094.html