Antidepressants are a class of medications that are primarily used to treat depression, but some of them have also been found to be effective in managing certain types of chronic pain, such as neuropathic pain, and chronic back pain. They work by altering the levels of certain neurotransmitters, such as serotonin and norepinephrine, in the brain. These neurotransmitters play a role in regulating mood, pain, and other bodily functions.
How Antidepressants Work for Pain
Antidepressants are a class of medications that are primarily used to treat depression, but some of them have also been found to be effective in managing certain types of chronic pain, such as neuropathic pain, and chronic back pain.
They work by altering the levels of certain neurotransmitters, such as serotonin and norepinephrine, in the brain. These neurotransmitters play a role in regulating mood, pain, and other bodily functions. Modulating the activity of these neurotransmitters can reduce pain signals being sent to the brain.
Some antidepressants are believed to help reduce chronic pain by decreasing the amount of substance P, a chemical in the body that is involved in pain perception.
Classes of Antidepressants
Antidepressants are sometimes used to treat chronic pain, as they can help to reduce pain and improve mood. The following are the main classes of antidepressants that are used to treat chronic pain:
- Tricyclic Antidepressants (TCAs): These are older antidepressants that block the reuptake of both serotonin and norepinephrine, which are neurotransmitters involved in pain perception and mood regulation. Examples of TCAs include amitriptyline (Elavil) and nortriptyline (Pamelor).
- Selective Serotonin Reuptake Inhibitors (SSRIs): These are newer antidepressants that specifically target the reuptake of serotonin, which is a neurotransmitter involved in pain perception and mood regulation. They are used to treat chronic pain, including headaches and neuropathic pain, as well as depression. Examples of SSRIs include fluoxetine (Prozac) and sertraline (Zoloft).
- Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): These antidepressants target the reuptake of both serotonin and norepinephrine, which are neurotransmitters involved in pain perception and mood regulation. They are used to treat chronic pain, including neuropathic pain and fibromyalgia. Examples of SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor).
The specific type of antidepressant used to treat pain will depend on the individual’s needs and the type of pain they are experiencing. A doctor will determine the most appropriate treatment for an individual based on their individual needs and circumstances. It is also important to note that not all people with chronic pain will benefit from using antidepressants, and that these medications may not be effective for all types of pain. In some cases, a combination of medications and other treatments, such as physical therapy or counseling, may be recommended.
As with any medication, there is the risk of side effects. Some side effects include:
- Sexual dysfunction
- Weight gain
- Dry mouth
Antidepressants can take several weeks to start working, and are generally used as a part of a multidisciplinary treatment plan for chronic pain that may include physical therapy, psychological support, and other medications.
Who should avoid taking antidepressants?
Antidepressants should be used with caution in certain individuals who may be at higher risk of side effects or other adverse reactions. The following are some groups of people who should avoid taking antidepressants for chronic pain or who should use these medications with caution:
- Pregnant women: Some antidepressants may cause preterm birth or other issues in pregnancy.
- History of seizures: Some antidepressants (the TCA class) can lower the seizure threshold , which can increase the risk of seizures in people with a history of epilepsy
- History of mania or bipolar disorder: Antidepressants can trigger manic episodes in people with bipolar disorder, so they may need to avoid taking them.
Are anti-depressants right for me?
Whether or not antidepressants are the right treatment option for your back pain depends on the underlying cause of your pain and the severity of your symptoms. It is best to consult with a doctor who can evaluate your individual situation and make a recommendation.