Treatment of Fibromyalgia Syndrome With Antidepressants: A Meta-analysis

• Published in: JAMA : the journal of the American Medical Association 2009-01, Vol.301 (2), p.198-209
• Main Authors: Häuser, Winfried, Bernardy, Kathrin, Üçeyler, Nurcan, Sommer, Claudia
• Format: Article
• Language: English
• Subjects: Antidepressants; Antidepressive Agents - therapeutic use; Biological and medical sciences; Clinical trials; Diseases of the osteoarticular system; Drug therapy; Fibromyalgia; Fibromyalgia - drug therapy; General aspects; Humans; Medical sciences; Meta-analysis; Miscellaneous. Osteoarticular involvement in other diseases; Neuropharmacology; Pain management; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Quality of life; Randomized Controlled Trials as Topic; Reproducibility of Results; Systematic review
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2008.944

CONTEXT Fibromyalgia syndrome (FMS) is a chronic pain disorder associated with multiple debilitating symptoms and high disease-related costs. Effective treatment options are needed. OBJECTIVES To determine the efficacy of antidepressants in the treatment of FMS by performing a meta-analysis of randomized controlled clinical trials. DATA SOURCES MEDLINE, PsycINFO, Scopus, and the Cochrane Library databases were searched through August 2008. Reference sections of original studies, meta-analyses, and reviews on antidepressants in FMS were reviewed. STUDY SELECTION Randomized placebo-controlled trials with tricyclic and tetracyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs) were analyzed. DATA EXTRACTION AND DATA SYNTHESIS Two authors independently extracted data. Effects were summarized using standardized mean differences (SMDs) by a random-effects model. RESULTS Eighteen randomized controlled trials (median duration, 8 weeks; range, 4-28 weeks) involving 1427 participants were included. Overall, there was strong evidence for an association of antidepressants with reduction in pain (SMD, −0.43; 95% confidence interval [CI], −0.55 to −0.30), fatigue (SMD, −0.13; 95% CI, −0.26 to −0.01), depressed mood (SMD, −0.26; 95% CI, −0.39 to −0.12), and sleep disturbances (SMD, −0.32; 95% CI, −0.46 to −0.18). There was strong evidence for an association of antidepressants with improved health-related quality of life (SMD, −0.31; 95% CI, −0.42 to −0.20). Effect sizes for pain reduction were large for TCAs (SMD, −1.64; 95% CI, −2.57 to −0.71), medium for MAOIs (SMD, −0.54; 95% CI, −1.02 to −0.07), and small for SSRIs (SMD, −0.39; 95% CI, −0.77 to −0.01) and SNRIs (SMD, −0.36; 95% CI, −0.46 to −0.25). CONCLUSION Antidepressant medications are associated with improvements in pain, depression, fatigue, sleep disturbances, and health-related quality of life in patients with FMS.