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Medicine for Depression & Chronic Pain

According to Rachel Wurzman, M.S.; Wayne Jonas, M.D.; and James Giordano, Ph.D., more than 65 percent of individuals with chronic pain have a history of major depression, which is almost four times the rate of major depression in the general population. Medications are available that treat both chronic pain and depressive symptoms.

  1. Types of Medication

    • Two types of antidepressants are commonly used for treating chronic pain: tricyclics (TCAs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). TCAs include Elavil (amitriptyline), Tofranil (imipramine) and Anafranil (clomipramine). SNRIs include Effexor (venlafaxine) and Cymbalta (duloxetine).

    Types of Pain

    • Antidepressants are typically used to treat certain types of pain, including diabetic neuropathy, pain caused by shingles, tension headaches, migraines, fibromyalgia and lower back pain.

    Function

    • It is unclear what the exact role of TCAs and SNRIs are in treating chronic pain. However, TCAs and SNRIs increase levels of certain neurotransmitters, including norepinephrine and serotonin, that play a role in regulating mood.

    Side Effects

    • Common side effects of TCAs and SNRIs include fatigue, dry mouth, constipation, weight gain, changes in blood pressure and gastrointestinal disturbances.

    Opiate Pain Medications

    • Opiate pain medications, such as hydrocodone and oxycodone, may cause depressive symptoms to become worse. These medications also have a high potential for abuse and may be used to "self-medicate" for depression.

    Warning

    • Discontinuation syndrome may result after discontinuing SNRIs after long-term use. Symptoms of discontinuation syndrome include dizziness, mood swings, anxiety, insomnia, irritability, "electric shock" sensations throughout the body, tremor and chills, and typically last for one to three weeks.

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