Fibromyalgia is classed as a disorder of pain processing due to abnormalities in how pain signals are processed in the central nervous system. 1

Antidepressants are now the most widely studied and, for certain, the most successful therapy of fibromyalgia (Goldenberg et al 2004 2; Bennett 2005 3) 4

Also according to an article on fibromyalgia-symptoms.org 5 when people with fibromyalgia receive antidepressant prescriptions, it is typically in order to interrupt pain cycles and restore restful sleep. Antidepressants are prescribed in lower-than-usual doses in order to treat these symptoms.

It seems that antidepressants are only used to reduce fibromyalgia related symptoms such as interruption of pain cycles and restoring restful sleep. Can't those symptoms be managed with pain killers (NSAIDs) and sleeping medication? Don't anti-depressants have a lot of unwanted side-effects like suppressing (sensing of) certain brain activity? I don't understand why anti-depressants are used in this case.

1 https://en.wikipedia.org/wiki/Fibromyalgia
2 https://www.ncbi.nlm.nih.gov/pubmed/15547167
3 https://www.ncbi.nlm.nih.gov/pubmed/16174485
4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671948/
5 https://www.fibromyalgia-symptoms.org/fibromyalgia_antidepressants.html

  • 2
    One hypothesis about the mechanism of fibromyalgia is central sensitization with lowered pain threshold and inability to respond to stress. This is why most classical painkillers don't work. There is currently no real agreement if any pharmacological therapy, including antidepressants, works. I believe it's more a psychogenic than organic problem. Antidepressant may mask the pain by making someone dull - but that's not really a solution.
    – Jan
    Dec 4 '19 at 18:53
  • "Can't those symptoms be managed with pain killers (NSAIDs) and sleeping medication?" -- They can, but not well, which is obvious because otherwise fibromyalgia would be easily treated and it's clearly not. Long-term NSAID use has risks that can be dangerous, some people can't take them at all, and long-term sleep med usage has its own set of risks. Personally, I'd choose a low dose of an antidepressant long before I'd use NSAIDs or sleep aids long term.
    – Carey Gregory
    Dec 5 '19 at 1:19
  • I suggest that NSAIDs (anti-inflammatory drugs) have only little benefit as there is no evidence of inflammation in fibromyalgia. This is a complex area and often not intuitive. Good question!
    – Chris
    Dec 5 '19 at 7:17
  • Chronic pain and depression often run side-by-side as the patient cannot see an end to the situation. The depression can lead to more pain sensation which is a psychosomatic aspect to pain related depression (although the underlying chronic pain is definitely not psychosomatic) therefore antidepressants can help to alleviate this aspect of the problem. Pain psychology is a large area of research which links into the management of Fibromyalgia but not just pain psychology. The neuroscience behind Fibromyalgia is very young and more is being learnt all the time. Dec 5 '19 at 20:05

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