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It is interesting to know that most antidepressants are prescribed to people who are not depressed. Unknown to many, antidepressants are often prescribed to treat chronic illnesses, especially neuropathic pain like chronic low er back and neck pain.

FDA approved to treat pain

Some antidepressants are included in the guidelines to treat lower back pain and osteoarthritis. Duloxetine, in particular, is very common and is even FDA-approved to treat arthritis.

Exactly how antidepressants reduce pain is still a mystery. One line of thought is that they affect some of the chemicals in the brain responsible for the perception of pain. The mechanism, however, differs from how they reduce depression.

Antidepressants are not the first prescription that people are suffering from chronic lower back pain and arthritis receive. The first treatment is usually exercise, physical therapy, weight loss therapy, cortisone injections, or anti-inflammatory drugs (NSAIDs). Doctors only try antidepressants when these treatments fail.

When treating these chronic pain conditions, the doctors initially prescribe antidepressants at low dosages, lower than the base dosage for depression patients. They increase the dosage gradually until the pain is controlled and keep it at the lowest effective dosage. The doctor can also recommend switching to a different antidepressant if one is not effective, there is interaction with other medication, or has adverse side effects.

Previous studies on the use of antidepressants on chronic pain like amitriptyline on knee and neck pain showed modest short-term pain relief. However, the studies were limited in that they were short-term, lasting only a few months. It is also important to note that side effects like erectile dysfunction and constipation were present in these studies.

Bad results

A new study combined with previous research tried to find out if antidepressants were safe for these conditions. The results were anything but encouraging.

  1. Treating pain with antidepressants was ineffective, scoring about 4 points on a 0 to 100 scale.
  2. People who were using antidepressants for pain relief stopped because it had adverse side effects, was ineffective, or both.
  3. People with both depression and chronic pain did not experience more improvement than people with chronic pain alone.

These findings increase the doubt towards using antidepressants as pain relief. They, however, show that antidepressants might work more for some people than for others.