08 September 2008
A systematic review on the effectiveness of treatment with
antidepressants in fibromyalgia syndrome.
Arthritis Rheum. 2008 Aug 29;59(9):1279-1298. [Epub ahead of print]
Uçeyler N, Häuser W, Sommer C.
University of Würzburg, Würzburg, Germany.
PMID: 18759260
OBJECTIVE: To systematically review the efficacy of treatment of
fibromyalgia syndrome (FMS) with antidepressants.
METHODS: We screened Medline, PsychINFO, SCOPUS, and the Cochrane
Library databases (through October 2007) and the reference sections
of original studies, meta-analyses, and evidence-based guidelines and
recommendations on antidepressants in FMS. Randomized controlled
trials (RCTs) on the treatment of FMS with antidepressants were
analyzed. Inclusion criteria, study characteristics, quality, and all
outcome measures were investigated.
RESULTS: Twenty-six of 167 studies were included. The main outcome
variables reviewed were pain, fatigue, sleep, depressiveness, and
quality of life. Amitriptyline, studied in 13 RCTs, was efficient in
reducing pain with a moderate magnitude of benefit (pain reduction by
a mean of 26%, improvement in quality of life by 30%). Selective
serotonin reuptake inhibitors (SSRIs) were studied in 12 RCTs, which
also showed positive results, except for 2 studies on citalopram and
1 on paroxetine. Three RCTs on the dual serotonin and noradrenaline
reuptake inhibitors (SNRIs) duloxetine and milnacipran and 1 of the 2
RCTs using the monoamine oxidase inhibitor moclobemide reported a
positive result. The longest study duration was 12 weeks.
CONCLUSION: Amitriptyline 25-50 mg/day reduces pain, fatigue, and
depressiveness in patients with FMS and improves sleep and quality of
life. Most SSRIs and the SNRIs duloxetine and milnacipran are
probably also effective. Short-term treatment of patients with FMS
using amitriptyline or another of the antidepressants that were
effective in RCTs can be recommended. Data on long-term efficacy are
lacking.