My doctor diagnosed me with fibromyalgia and then told me I should be taking an antidepressant. I'm confused because I don't think I'm depressed. I don't understand why he wants to put me on this drug. Does he think it's all in my head and that I'm not really sick?
This is a common point of confusion when it comes to treating fibromyalgia or the similar condition chronic fatigue syndrome.
The right answer to your question depends on your doctor. Some doctors, sadly, do still think that fibromyalgia or chronic fatigue syndrome symptoms are the result of major depressive disorder, the inability to cope with the difficulties of life or other mental-health or personality-based issues.
However, more enlightened doctors also frequently prescribe antidepressants for us, and a wealth of scientific evidence supports that decision – not because we're all depressed (we're not), but because of the underlying physiology the drugs are aimed at modifying.
Depression, fibromyalgia and chronic fatigue syndrome all share certain features, including imbalances of brain chemicals called neurotransmitters. Those are the things that transmit messages from one brain cell to another.
Three important neurotransmitters are believed to be involved in all of these conditions, and each may contribute to multiple symptoms or dysfunctions. The neurotransmitters and some of their areas of influence are:
- Serotonin: pain regulation, sleep quality, fatigue level, appetite, temperature regulation, mood, emotion, libido. (Learn more about serotonin.)
- Norepinephrine: alertness, memory, level of interest, concentration, sleep. (Learn more about norepinephrine.)
- Dopamine: fine motor skills, muscle function, cognitive function, attention, balance. (Learn more about dopamine.)
Antidepressants influence the way your brain uses neurotransmitters, so they may help curb the symptoms of fibromyalgia and chronic fatigue syndrome in people who aren't depressed. Two of the three fibromyalgia drugs approved by the U.S. Food and Drug Administration (FDA) – Cymbalta (duloxetine) and Savella (milnacipran) – are antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRIs). Other antidepressants are prescribed off-label for these conditions, particularly fibromyalgia. They include selective serotonin reuptake inhibitors (SSRIs) and tricyclics.
While antidepressants do work for many people with fibromyalgia and possibly for those with chronic fatigue syndrome, they don't work for everyone, and they're not a cure. Most people need to combine several different forms of treatment to get substantial symptom relief. It's also important to watch for side effects and take these medications exactly how they're prescribed.
It's also true that many people with fibromyalgia or any chronic illness are at risk for depression, but even a mental-health diagnosis such as major depressive disorder doesn't mean what you're feeling is "all in your head." Depression has physiological causes and often improves with physiological treatments.
- Fibromyalgia Treatment Options
- Chronic Fatigue Syndrome Treatment Options
- Understanding & Treating Depression in FMS & ME/CFS
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