The overview of research found that no studies provided high quality evidence that antidepressants were effective for pain, despite their increased use for common pain conditions.
Antidepressants are medications used to treat a variety of mental health conditions, including depression, anxiety, and obsessive-compulsive disorder (OCD). However, they are also used to treat chronic pain from conditions such as fibromyalgia and osteoarthritis.
Antidepressant use for chronic pain is on the rise, but questions remain on their effectiveness.
In a new study published on February 1 in The BMJ, scientists examined 26 eligible research reviews published between 2012 and 2022 comparing an antidepressant with a placebo in treating pain conditions in adults.
The reviews looked at the use of eight antidepressant classes in 22 pain conditions. Forty-five percent of the trials had connections to the industry, which the authors say may have influenced the results.
After assessing the reviews, the scientists found evidence that some antidepressants — mostly serotonin-norepinephrine reuptake inhibitors (SNRIs) — were more effective than a placebo when prescribed for 11 pain conditions.
For example, scientists found moderate evidence that SNRIs were effective for chronic back pain, postoperative pain, fibromyalgia, and neuropathic pain. They also identified that selective serotonin reuptake inhibitors (SSRIs) were moderately effective in people with depression and chronic pain.
However, low quality evidence suggested that SNRIs were effective for pain associated with breast cancer treatment, knee osteoarthritis, depression, and other underlying conditions. Moreover, tricyclic antidepressants (TCAs) showed some evidence that they were effective for irritable bowel syndrome (IBS), neuropathic pain, and chronic tension-type headaches.
Yet, no review found high quality evidence that antidepressants were effective for pain. Furthermore, 31 comparisons were either inconclusive or showed that antidepressants were ineffective for common pain conditions.
In addition, four reviews found evidence that a placebo was more effective than an antidepressant for pain relief.
In an editorial linked to the study, Cathy Stannard, clinical lead for pain transformation, and Colin Wilkinson, chair of the Consortium Public Advisory Group, wrote:
"Ferreira and colleagues explored the effectiveness of antidepressants in a wider range of chronic pain conditions. They reported that just 11 of 42 comparisons—in nine of 22 chronic pain conditions—showed some evidence of effectiveness, but none of this evidence was of high quality. Their findings suggest that for most adults living with chronic pain, antidepressant treatment will be disappointing."
The study authors note that their findings suggest a more nuanced approach to prescribing antidepressants for pain is needed.
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