The Role of Antidepressants in the Management of Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis
CNS Drugs,  Evidence Based Medicine  Clinical Article

Hauser W et al. – The tricyclic antidepressant (TCA) amitriptyline and the serotonin noradrenaline (norepinephrine) reuptake inhibitors (SNRIs) duloxetine and milnacipran are first–line options for the treatment of fibromyalgia syndrome (FMS) patients. Physicians and patients should be realistic about the potential benefits of antidepressants in FMS. A small number of patients experience a substantial symptom relief with no or minor adverse effects. However, a remarkable number of patients dropout of therapy because of intolerable adverse effects or experience only a small relief of symptoms, which does not outweigh the adverse effects.

Methods
  • Studies with a randomized controlled trial (RCT) design comparing any types of antidepressants with pharmacological placebo or head–to–head comparisons of different types of antidepressants in FMS patients were included.
  • RCTs in which antidepressants were combined with any other defined treatment or antidepressants were tested against anything but drug placebo were excluded.
  • Patients diagnosed with FMS according to predefined criteria of any age were included.
  • To be included, studies had to assess at least one key domain of FMS (pain, sleep, fatigue, health–related quality of life [HRQOL]) as outcomes of efficacy and report total treatment discontinuation rates and/or dropout rates due to adverse events as outcomes for harms.
  • Data were extracted according to protocols of previous systematic reviews on antidepressants in FMS.
  • Methodology quality was assessed by the van Tulder score.
  • Standardized mean differences (SMD) were calculated for continuous outcomes by means and standard deviations and relative risks (RR) for 30% pain reduction and total dropout rate for comparisons of antidepressants with placebo.
  • Examination of the combined results was performed by a random effects model.
  • The authors used Cohen's categories to evaluate the magnitude of the effect size, calculated by SMD.
  • Heterogeneity was tested by the I2 statistic.
  • Thirty–five studies were included in the meta–analysis.

Results
  • The SMDs of serotonin noradrenaline (norepinephrine) reuptake inhibitors (SNRIs) on pain, sleep, fatigue, depression and HRQOL were significant.
  • Based on Cohen's categories, the effect size on pain was small and the ones on sleep, fatigue, depression and HRQOL were not substantial.
  • 1481/3528 (42.0%) patients with SNRIs and 737/2304 (32.0%) patients with placebo reported a 30% pain reduction (number needed to treat [NNT] 10.0; 95% CI 8.00, 13.4; I2=4%).
  • The RR of dropouts due to adverse events was 1.83 (95% CI 1.53, 2.18; I2=33%).
  • The SMDs of selective serotonin reuptake inhibitors (SSRIs) on pain, sleep, depression and HRQOL were significant.
  • Based on Cohen's categories, the effect sizes on pain, depression and HRQOL were small and the one on sleep not substantial.
  • 72/198 (36.4%) patients with SSRIs and 40/194 (20.6%) patients with placebo reported a 30% pain reduction (NNT 6.3; 95% CI 4.1, 14.1).
  • The RR of dropouts due to adverse events was 1.60 (95% CI 0.84, 3.04; I2=0%).
  • The SMDs of tricyclic antidepressants (TCAs) on pain, sleep, fatigue and HRQOL were significant.
  • Based on Cohen's categories, the effect sizes on pain and sleep were moderate and the ones on fatigue and HRQOL were small.
  • 140/290 (48.3%) patients with TCAs and 70/252 (27.8%) patients with placebo reported a 30% pain reduction (NNT 4.9; 95% CI 3.5, 8.0).
  • The RR of dropouts due to adverse events was 0.84 (95% CI 0.46, 1.52; I2=0%).

Please login or register to follow this author.
Are you sure you want to Unfollow this Author?
► Click here to access PubMed, Publisher and related articles...
<< Previous Article | Next Article >>

Your Unread Messages in Psychiatry

See All >> Messages include industry-sponsored communications and special communications from MDLinx

Most Popular Psychiatry Articles

1 Zolpidem and the risk of Parkinson's disease: A nationwide population-based study Journal of Psychiatric Research, August 1, 2014    Clinical Article

2 Antidepressants and the risk of hyponatraemia: A class-by-class review of the literature Psychosomatics, September 15, 2014    Review Article

3 Comparison of metabolic effects of aripiprazole, quetiapine and ziprasidone after 12 weeks of treatment in first treated episode of psychosis Schizophrenia Research, September 24, 2014    Clinical Article

4 Guanfacine for attention deficit and hyperactivity disorder in pediatrics: a systematic review and meta-analysis European Neuropsychopharmacology, September 2, 2014    Evidence Based Medicine    Review Article

5 Prazosin in the treatment of PTSD Journal of Psychiatric Practice, July 25, 2014    Review Article

6 Association between early temperament and depression at 18 years Depression and Anxiety, August 18, 2014    Clinical Article

7 The effect of bupropion XL and escitalopram on memory and functional outcomes in adults with major depressive disorder: Results from a randomized controlled trial Psychiatry Research, August 5, 2014    Clinical Article

8 Adipokines as emerging depression biomarkers: A systematic review and meta-analysis Journal of Psychiatric Research, September 18, 2014    Evidence Based Medicine    Clinical Article

9 Latent inhibition in ADHD adults on and off medication: A preliminary study Journal of Attention Disorders, September 10, 2014    Clinical Article

10 Curcumin for the treatment of major depression: A randomised, double-blind, placebo controlled study Journal of Affective Disorders, July 17, 2014    Clinical Article

11 Adipokines as emerging depression biomarkers: A systematic review and meta-analysis Journal of Psychiatric Research, September 3, 2014    Evidence Based Medicine    Clinical Article

12 Third-wave cognitive therapy versus mentalisation-based treatment for major depressive disorder: a randomised clinical trial BMJ Open, September 9, 2014    Clinical Article

13 The importance of cytokines and autoantibodies in depression Autoimmunity Reviews, September 25, 2014    Review Article

14 Risk of diabetes in children and adolescents exposed to antipsychotics: A nationwide 12-year case-control study Journal of the American Academy of Child & Adolescent Psychiatry, September 4, 2014    Clinical Article

15 Increased cortisol awakening response was associated with time to recurrence of major depressive disorder Psychoneuroendocrinology, August 22, 2014    Clinical Article

16 Association between autoimmune thyroiditis and depressive disorder in psychiatric outpatients European Archives of Psychiatry and Clinical Neuroscience, September 17, 2014    Clinical Article

17 Oral contraceptive use and psychiatric disorders in a nationally representative sample of women Archives of Women's Mental Health, August 29, 2014    Clinical Article

18 Vascular Endothelial Growth Factor: A potential diagnostic biomarker for major depression Journal of Psychiatric Research, September 19, 2014    Clinical Article

19 Efficacy of acupuncture in reducing preoperative anxiety: a meta-analysis Full Text Evidence-based Complementary and Alternative Medicine , September 5, 2014    Free full text    Evidence Based Medicine    Review Article

20 Metacognitions and thought control strategies in unipolar major depression: A comparison of currently depressed, previously depressed, and never-depressed individuals Cognitive Therapy and Research, September 5, 2014    Clinical Article

Indexed Journals in Psychiatry : Current Psychiatry, Bipolar Disorders, American Journal of Psychiatry, Addictionmore

Register now to view all the MDLinx contents (FREE)!

  • Stay current on the latest literature, research and clinical news
  • Get special communications and offers from MDLinx and our sponsors
  • Receive invitations to paid market research
View Samples and Register

Connect with us, stay current.

Receive the latest mecial news
updates for free via email

Sign up!

Subscribe to our free RSS feeds:

Get the latest news in your specialty automatically added to your newsreader or your personal My Yahoo!, Google, My MSN or My AOL page. Learn More

Close