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Treatment of fibromyalgia with antidepressants

A meta-analysis

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Abstract

BACKGROUND: Fibromyalgia is a common, poorly understood musculoskeletal pain syndrome with limited therapeutic options.

OBJECTIVE: To systematically review the efficacy of antidepressants in the treatment of fibromyalgia and examine whether this effect was independent of depression.

DESIGN: Meta-analysis of English-language, randomized, placebo-controlled trials. Studies were obtained from searching medline, embase, and psyclit (1966-1999), the Cochrane Library, unpublished literature, and bibliographies. We performed independent duplicate review of each study for both inclusion and data extraction.

MAIN RESULTS: Sixteen randomized, placebo-controlled trials were identified, of which 13 were appropriate for data extraction. There were 3 classes of antidepressants evaluated: tricyclics (9 trials), selective serotonin reuptake inhibitors (3 trials), and S-adenosylmethionine (2 trials). Overall, the quality of the studies was good (mean score 5.6, scale 0–8). The odds ratio for improvement with therapy was 4.2 (95% confidence interval [95% CI], 2.6 to 6.8). The pooled risk difference for these studies was 0.25 (95% CI, 0.16 to 0.34), which calculates to 4 (95% CI, 2.9 to 6.3) individuals needing treatment for 1 patient to experience symptom improvement. When the effect on individual symptoms was combined, anti-depressants improved sleep, fatigue, pain, and well-being, but not trigger points. In the 5 studies where there was adequate assessment for an effect independent of depression, only 1 study found a correlation between symptom improvement and depression scores. Outcomes were not affected by class of agent or quality score using meta-regression.

CONCLUSION: Antidepressants are efficacious in treating many of the symptoms of fibromyalgia. Patients were more than 4 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.

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Author information

Authors and Affiliations

  1. the Division of General Internal Medicine, Walter Reed Army Medical Center, Washington DC

    Patrick G. O’Malley MD, MPH (Assistant Professor of Medicine), Erin Balden MD, MPH & Glen Tomkins MD, MPH

  2. Uniformed Services University of the Health Sciences, Bethesda, Md

    Patrick G. O’Malley MD, MPH (Assistant Professor of Medicine) & Jeffrey L. Jackson MD, MPH

  3. William Beaumont Army Medical Center, El Paso, Tex

    James Santoro MD, MPH

  4. the Regenstrief Institute for Health Care, Indiana University School of Medicine, Indianapolis, Ind

    Kurt Kroenke MD

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  1. Patrick G. O’Malley MD, MPH
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  2. Erin Balden MD, MPH
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  4. James Santoro MD, MPH
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  6. Jeffrey L. Jackson MD, MPH
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The opinions or assertions herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.

Supported by a grant from the MacArthur Foundation Initiative on Depression in Primary Care (PGO).

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O’Malley, P.G., Balden, E., Tomkins, G. et al. Treatment of fibromyalgia with antidepressants. J GEN INTERN MED 15, 659–666 (2000). https://doi.org/10.1046/j.1525-1497.2000.06279.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2000.06279.x

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