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Adrienne Dellwo

Antidepressants for Fibromyalgia: Do They Work Long-Term?

By September 4, 2013

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Research Brief

A recent study suggests that antidepressants may not be effective in the long-term as a fibromyalgia treatment.

Antidepressants are an extremely common treatment for this condition, and two of the three drugs FDA-approved for it - Cymbalta (duloxetine) and Savella (milnacipran) - are a type of antidepressant called SNRI. (Milnacipran isn't approved for depression in the U.S., but it is an approved depression drug in multiple countries.)

This small study was a one-year follow-up of 23 women with fibromyalgia. Participants were evaluated by multiple methods at the beginning and end of the study. At the end of the year, researchers found that members of antidepressant group:

  • Were more severely impacted by fibromyalgia;
  • Had more disability linked to symptoms of bipolar disorder;
  • Had more severe depression.

Researchers do state that this study is limited because of its size and because it wasn't specifically designed to test for these measures. However, it does point to a need for more research into the long-term effect of these drugs.

What Does it Mean for Us?

Sometimes, people see a study like this and run to their doctors demanding a change in medication. Is this something you should do?

That's a decision only you can make, and I hope that you involve your doctor in drug decisions. If I were on an antidepressant and it was working for me, I wouldn't necessarily make an immediate change. However, I would pay close attention to what my symptoms did over time. A symptom journal can really help with that kind of thing.

If you've been on an antidepressant for a long time and you're concerned about whether it's working, you might want to talk to your doctor about a drug holiday. That's when you wean off of your meds, stay off of them for long enough to see how it effects you, and then re-start them.

If you do decide to stop taking an antidepressant, make sure you wean off of it the right way! Stopping too abruptly can cause discontinuation syndrome, which can be extremely hard on your body. Here's more information on that:

While there's great information there, you should be sure to talk to your doctor before changing anything about your medications.

To explore treatment options that don't involve antidepressants, see:

Do you think antidepressants have made you worse? Have they helped you? Does this study make you re-consider them? Leave your comments below!

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Comments
September 5, 2013 at 6:51 am
(1) Sleep Mode zZ says:

The study really have a too small sample to make any conclusions. But it brings up the important question: Why is there no real studies on the long-term effiency of antidepressants for fibromyalgia? Fibromyalgia is a chronic condition and medication that is only efficient for some months (for some people, to some degree) would be close to useless. And, if it really has negative effects in the long run, it should be classified as harmful.

These medicines are approved for the treatment of fibromyalgia and they had to prove their effiency to be approved. What time span was used in those trials?

September 5, 2013 at 7:29 am
(2) Sleep Mode zZ says:

To give an aswer to my own question:

Concerning Cymbalta there are two 12-week, two 6-month and one 1-year study. Most interesting is the 1-year study with 350 subjects that found that pain reduction continued during the year. So it seems that it contradicts the result from the small study where the members of the antidepressant group were more severely impacted by fibromyalgia.

The adverse effects reported in the study do not include mental health problems like bipolar disorder and depression depression. They could have gone unnoticed?

Chappell AS, Littlejohn G, Kajdasz DK, et al. 1-year safety and efficacy study of duloxetine in patients with fibromyalgia. Clin. J. Pain. 2009;25(5):365375.

September 5, 2013 at 3:07 pm
(3) Nanax3 says:

I have fibro and major long-term depression. I have found that I have had to change anti-depressants because they seem to stop working. But I take Cymbalta and Lexapro..I never have changed the Cymbalta tho.

September 6, 2013 at 4:23 pm
(4) Janet Busvek says:

Since I have started Earthing I have gotten off of medications for my fibromyalgia. Look up Earthing and read book and judge for yourself. I sure am happy about the way I feel now.

September 6, 2013 at 4:24 pm
(5) marc penn sr says:

Anti depressants are simply a cop out for people who can not diagnose.
They are ONLY for people who ARE depressed.If you are NOT,they have a nasty side efffect of MAKING you depressed.
I have had fibromyalgia for more than 30 years,been on all the popular “meds de jour”(whatever the latest “thinking” is on fibromyalgia):
simply find what works best for YOU.
It is a VERY individualized disease.
What works for “most” may NOT work for you.
HANG IN THERE!!!!

September 6, 2013 at 6:17 pm
(6) Lucy says:

My first gripe with anti-depressants is that as soon as a woman talks about chronic pain, inability to sleep well, etc, they say “oh, you must be depressed” and if they just give you a happy pill you will go on your way and not bother them again.

Then they came out with SSRI and related drugs and all of a sudden they want to put you on one for depression, another for pain and maybe even a 3rd for sleep. Pretty soon, you are into serotonin syndrome, a potentially life threatening problem.

Then you have to “wean’ off of them. However, many SSRI are time released. So, weaning down only works so far.

I “weaned” down from these after developing serotonin syndrome and I can attest to the fact that it has to be a lot like coming off of a narcotic addiction. I nearly crawled out of my skin and up the walls for nearly a week and slept little the whole time.

The docs did this to me twice, the second time assuring me that the “new SSRI” wouldn’t do that.

Never again. I now list SSRI drugs as something I’m allergic to so that they don’t keep pushing them.

September 6, 2013 at 9:45 pm
(7) Dawn says:

I have heard great things about LDN (low dose naltrexone) for fm and after being on antid’s for years and now being housebound, I am determined to try ldn. No doc ever suggested it which is annoying,

September 6, 2013 at 10:33 pm
(8) leona says:

I don’t trust antidepressants, but they did help me sleep for a year–now they aren’t helping as much. But I am still on them. Lyrica helps me more than anything, but I know quite a few people aren’t so fortunate.

I also tried low dose naltrexone for 6 months. I’d read a lot of posts from people raving about how much it helped them, so I wanted to try it. It didn’t help me, but it helps many, so good luck with it.

September 7, 2013 at 4:24 am
(9) dawn says:

thanks so much Leona. I do hope for help. LDN is kinda a last ditch effort.
Sorry it did not help you, I have seen the rave comments also.

This disease is so complex no one size :( .
Wish and pray we all could find something.
God bless

September 7, 2013 at 12:17 pm
(10) jip says:

I am reading comments here that reflect a lack of information about antidepressants (SSRIs). I don’t really understand all of the biochemistry, but they work (when they do) in a complex way that is not just alleviation of depression. I understand a large part of it is helping the patient get the deep sleep that is needed to restore the body.

The studies mentioned by Adrienne seem to me much too short to really determine if the SSRIs stop working. For me Cymbalta worked for at least five years, but now it seems to not do much. But how can I know? Maybe my muscle pain just became worse, and the SSRI cannot manage the increase. As I said, it’d complex.

September 7, 2013 at 12:47 pm
(11) Paula says:

When I was diagnosed with fibro, I was given an antidepressant that was the only option out there in 1997. I tried several different ones. I wasn’t depressed when I was put on them and I was taking Vicodin for pain. I never had the courage to get off them but I felt they were causing weight gain. When I was diagnosed with celiac disease; I said this is it; I am not taking them any more.

September 8, 2013 at 1:45 am
(12) Bobbi says:

I have been on various antidepressants since the 90s, starting for depression and PTSD and now for chronic depression, PTSD and fibromyalgia. Some have been great, others not so great, one made me feel suicidal. (The only time I’ve ever felt suicidal in my life).

It depends on the person. I’m lucky that Cymbalta is the most effective (now anyway) for my depression and that it happens to work well for my fibromyalgia pain as well. But Celexa worked well too so I’m glad I have that to go back to if I the Cymbalta ever stops working for me.

I’d kill to get on LDN but I get my meds through the VA and I know the only way I could ever get on LDN is if the associated med schoold did a trial. Keep your fingers crossed for me.

September 9, 2013 at 11:31 pm
(13) jules11 says:

I took savella and it did not help me at all. it made me freeze then sweat, upset my stomach, and did nothing for my pain anxiety or fibro fog. The thing is I dont have depression, I just have unbearable pain, foggy brain, trouble sleeping or no energy and stiffness. Im taking gabapentin right now which does help relieve the stiffness but not the pain. The problem is if I take more than one a day I do get depressed and feel hopeless. They really need to do more studies since so many people have it I really believe they could gind yhe cause and cure this

September 11, 2013 at 11:21 am
(14) JB says:

I was on anti-d’s for 11 years, was made to feel like I needed to be on them. Finally got game enough last year to challenge that view. The discontinuation syndrome for me was horrendous despite carefully tapering. Took over 6 weeks after discontinuing them for those nasty symptoms to wear off. Unfortunately I developed IBS after coming off, but now control that with FODMAPs. I do believe I feel better off them. Yes they did help modestly with pain but my overall health has improved. After having a very bad relapse earlier this year my docs pushed me to go back on them, I only lasted 2 weeks. The side effects just weren’t worth it. There have been times I do believe I needed to be on them but not for as long as I was so a larger study into their long term use I think is warranted. I think sometimes GP’s forget how sensitive we can be to meds.

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