Pain and depression are closely linked in the brain, and medications used in depression can be helpful in the controlling pain. Some antidepressants directly impact pain, while others only affect depression.
Antidepressants are most helpful in treating pain caused by damage to nerves or by an overactive nervous system (aka neuropathic pain). Specifically, antidepressant medications can help treat the following painful conditions:
- Diabetic neuropathy
- Shingles
- Fibromyalgia
Acute injury and surgical pain may be helped, but is still being studied.
Types of Antidepressants
There are two types of antidepressant medications that are used to control neuropathic pain:
- Tri-cyclic antidepressants (TCAs), such as amitriptyline, Nortriptyline, and desipramine
- Serotonin/noradrenaline reuptake inhibitors (SNRIs) such as Cymbalta and Savella
Antidepressants such as Zoloft, Prozac, Celexa, and Effexor have no affect on pain. These medications decrease nerve transmission and nerve sensitivity. The TCAs have many side affects including dry mouth, low blood pressure, sedation, and urinary problems. The newer SNRIs have very few side affects. Cymbalta is very effective in a number of neuropathic pain situations including diabetes, radiculopathy, and fibromyalgia, while Savella only is known to work in fibromyalgia.
Pain & Depression are Closely Linked
The nerve fibers that transmit pain sensation travel through the brain in the same regions that process emotional signals. These regions actually interact with each other. Stimulating depression centers can increase the perception of pain. When depression is not controlled, and a patient does have pain, rarely will the pain be controlled no matter what the treatment. Therefore, treating depression is often essential in effectively treating pain. Many people do not want to admit that they might be depressed, and thus not treating the depression does affect the pain level perceived.
Pain and depression in the brain are closely linked. Neuropathic pain is often treated with a variety of medications, many of which are antidepressants. Pain itself can change a person’s function and activity level, and cause depression. Treating the concomitant depression that pain may cause does help manage the severity of pain in many patients. Some medications treat both pain and depression, others may only treat depression, treating both together is often very effective in controlling pain.