Antidepressants for Fibromyalgia

A systematic review 1 including 13 studies with a total of 640 subjects was abstracted in DARE.

The myriad facets of fibromyalgia appear to be generally improved with the use of antidepressants. Patients are more than four times as likely to report overall improvement, and reported moderate reductions in individual symptoms, particularly pain. Whether this effect is independent of depression needs further study.

Overall, the OR for improvement with therapy was 4.2 (95% CI: 2.6 to 6.8). The pooled risk difference was 0.25 (95% CI: 0.16 to 0.34), and the NNT was 4 (95% CI: 2.9 to 6.3).

Continuous outcomes:

• the number of trigger points (10 trials) improved by 0.17 standard deviation (SD) units (95% CI: -0.07 to +0.42);
• pain scores (10 trials) improved by 0.52 SD units (95% CI: 0.21 to 0.81);
• sleep (8 trials) improved by 0.49 SD units (95% CI: 0.3 to 0.69);
• fatigue scores (8 trials) improved by 0.39 SD units (95% CI: 0.11 to 0.66); and
• overall well-being (7 trials) improved by 0.49 SD units (95% CI: 0.18 to 0.80).

Depression: only one study reported a correlation between treatment effect and change in depression scores. Thus, it could not be determined from these studies whether any effect demonstrated was independent of an effect on depression.

References

• O'Malley PG, Balden E, Tomkins G, Santoro J, Kroenke K, Jackson JL. Treatment of fibromyalgia with antidepressants: a meta-analysis. J Gen Intern Med 2000 Sep;15(9):659-66. [PubMed] [DARE]