Dr. Häuser has received consultant fees, speaking fees, and/or honoraria (less than $10,000) from Janssen-Cilag, Eli Lilly, and Mundipharma.
A systematic review on the effectiveness of treatment with antidepressants in fibromyalgia syndrome
Article first published online: 29 AUG 2008
Copyright © 2008 by the American College of Rheumatology
Arthritis Care & Research
Volume 59, Issue 9, pages 1279–1298, 15 September 2008
How to Cite
Üçeyler, N., Häuser, W. and Sommer, C. (2008), A systematic review on the effectiveness of treatment with antidepressants in fibromyalgia syndrome. Arthritis & Rheumatism, 59: 1279–1298. doi: 10.1002/art.24000
- Issue published online: 29 AUG 2008
- Article first published online: 29 AUG 2008
- Manuscript Accepted: 24 APR 2008
- Manuscript Received: 19 DEC 2007
- Bundesministerium für Bildung und Forschung
- Deutscher Forschungsverbund Neuropathischer Schmerz (German Research Network on Neuropathic Pain)
- intramural funds of the University of Würzburg
To systematically review the efficacy of treatment of fibromyalgia syndrome (FMS) with antidepressants.
We screened Medline, PsychINFO, SCOPUS, and the Cochrane Library databases (through October 2007) and the reference sections of original studies, meta-analyses, and evidence-based guidelines and recommendations on antidepressants in FMS. Randomized controlled trials (RCTs) on the treatment of FMS with antidepressants were analyzed. Inclusion criteria, study characteristics, quality, and all outcome measures were investigated.
Twenty-six of 167 studies were included. The main outcome variables reviewed were pain, fatigue, sleep, depressiveness, and quality of life. Amitriptyline, studied in 13 RCTs, was efficient in reducing pain with a moderate magnitude of benefit (pain reduction by a mean of 26%, improvement in quality of life by 30%). Selective serotonin reuptake inhibitors (SSRIs) were studied in 12 RCTs, which also showed positive results, except for 2 studies on citalopram and 1 on paroxetine. Three RCTs on the dual serotonin and noradrenaline reuptake inhibitors (SNRIs) duloxetine and milnacipran and 1 of the 2 RCTs using the monoamine oxidase inhibitor moclobemide reported a positive result. The longest study duration was 12 weeks.
Amitriptyline 25–50 mg/day reduces pain, fatigue, and depressiveness in patients with FMS and improves sleep and quality of life. Most SSRIs and the SNRIs duloxetine and milnacipran are probably also effective. Short-term treatment of patients with FMS using amitriptyline or another of the antidepressants that were effective in RCTs can be recommended. Data on long-term efficacy are lacking.