Why Antidepressants May Not Be Effective

 Researchers say that for the most part. Antidepressants are not effective in treating chronic pain.

Experts say non-opioid agents may be an alternative. They add that some pain relief can be 

achieved with exercise, acupuncture, and physical therapy. Antidepressants are effective in 

addressing mental health symptoms. But, using these drugs to relieve physical discomfort is 

ineffective. According to a study published today in The BMJ. Prescriptions for antidepressants 

have grown in recent decades. And spiked during the COVID-19 pandemic. While most of these 

prescriptions are intended to address depression. Researchers suspect that off-label prescriptions 

of antidepressants treat chronic pain. Fibromyalgia, persistent headaches, and osteoarthritis, also 

contributed to the trend. But, a systematic review of published studies on the use of 

antidepressants to treat pain. Found little evidence that these off-label prescriptions were 

effective. "No review provided high-quality evidence for the effectiveness of antidepressants. For 

pain in any condition," the study authors wrote. The researchers examined 42 studies.

They said only 11 studies, involving only nine of 22 chronic pain conditions, showed any evidence 

of effectiveness. For example, evidence classified as "moderate certainty" suggested that 

serotonin-norepinephrine reuptake inhibitors (SNRIs). May help with back pain, post-surgery 

pain, fibromyalgia, and neuropathic pain. "Low-certainty" evidence suggested that SNRIs help 

with pain associated with breast cancer treatment. Depression, osteoarthritis of the knee, and 

pain related to other underlying conditions. There was also low certainty of evidence that 

selective serotonin reuptake inhibitors (SSRIs). Were effective in people with depression and pain 

related to other conditions. There was also no significant evidence that tricyclic antidepressants 

(TCAs). Were effective in irritable bowel syndrome, neuropathic pain, and chronic tension-type 

headaches. Also, the researchers said they found no "high certainty" evidence. that any class of 

antidepressants are effective pain relievers. “Some antidepressants have been effective for some 

pain conditions; but, effectiveness appears to depend on the condition and class of 

antidepressant,". Says the multinational research team led by Dr. Giovanni Ferreira from the 

University of Sydney in Australia. "The findings suggest that a nuanced approach is needed 

when prescribing antidepressants for pain." The study suggests that "most adults living with 

chronic pain will. find antidepressant treatment disappointing," wrote Cathy Standard. A pain 

consultant at the UK's NHS Gloucestershire Integrated Care Board. And Colin Wilkinson of the 

University of Bath's Center for Pain Research. In an unaffiliated commentary published

alongside studies. "This is important given the emerging concerns about the increase in 

antidepressant prescriptions. And the problems patients describe when trying to stop treatment," 

she added. Dr. Alpo M. Patel is an assistant professor in the department of anesthesiology. 

Perioperative medicine and pain medicine at the Icahn School of Medicine at Mount Sinai in 

New York. Told the Health line that prescribing antidepressants for chronic pain is "not very 

common." "But, low-dose antidepressants such as tricyclic antidepressants may be prescribed to 

help with nerve-related pain," Patel said. ", they act as neuromodulatory drugs that can help 

reduce the sensation of pain." "Various reputable treatment guidelines recommend 

antidepressants as effective treatments for chronic pain,". Added Dr. “Painkillers, NSAIDs and 

opioids are more effective. But, [they are] associated with side effects and the risk of addiction.”

Whether they reduce pain or not, antidepressants still play a role in treating people who have 

chronic pain, experts said. "Currently, many other non-opiate agents are considered more viable 

and valuable. Antidepressants, either as a primary or adjunctive treatment for pain," said 

Dr. James Giordano, professor of neurology and biochemistry at Georgetown. Pellegrino Center 

for Clinical Bioethics University Medical Center in Washington, DC. “But, given that chronic 

pain can and very often presents as a set of signs and symptoms. Including mood, sleep, and

appetite changes, the use of antidepressants for their psychotropic effects can still be advocated 

and justified. Giordano told Health line. He added that antidepressants "may be used as 

adjunctive agents to treat comorbid pain and depression." The experts added that non-medical 

interventions, including exercise. acupuncture and physical therapy can also help people with 

chronic pain.