What role do antidepressants play in the management of fibromyalgia symptoms?

Antidepressants play a role in the management of fibromyalgia symptoms because fibromyalgia is classified as a type of chronic primary pain ¹. For individuals aged 18 years and over with chronic primary pain, antidepressants such as amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, or sertraline may be considered ¹. It is important to note that this is an off-label use of these medications for chronic primary pain ¹. When offered, it should be explained that these medicines may help with quality of life, pain, sleep, and psychological distress, even in the absence of a diagnosis of depression ¹. A Cochrane review indicated that duloxetine was moderately efficacious across all outcomes at a standard dose of 60 mg for chronic pain, while evidence for all other antidepressants was of low certainty ³. NICE guidelines advise against initiating other medications like antiepileptic drugs (including gabapentinoids), antipsychotics, benzodiazepines, non-steroidal anti-inflammatory drugs (NSAIDs), or opioids to manage chronic primary pain ¹. If a person with chronic primary pain is already taking any of these medicines, their prescribing should be reviewed as part of shared decision-making ¹. Specialist advice should be sought if pharmacological management with antidepressants is being considered for young people aged 16 to 17 years ¹. When making shared decisions about stopping antidepressants, discussions should include any problems associated with withdrawal ¹.