Antidepressants: Another weapon against chronic pain

Antidepressants are a mainstay in the treatment of many chronic pain conditions — even when depression isn't a factor. By Mayo Clinic Staff

Some of the more effective and commonly used medications for chronic pain are drugs that were developed to treat other conditions. Although not specifically intended to treat chronic pain, antidepressants are a mainstay in the treatment of many chronic pain conditions, even when depression isn't recognized as a factor.

Types of pain relieved

Antidepressants seem to work best for pain caused by:

  • Arthritis
  • Nerve damage from diabetes (diabetic neuropathy)
  • Nerve damage from shingles (postherpetic neuralgia)
  • Nerve pain from other causes (peripheral neuropathy, spinal cord injury, stroke, radiculopathy)
  • Tension headache
  • Migraine
  • Facial pain
  • Fibromyalgia
  • Low back pain
  • Pelvic pain

The painkilling mechanism of these drugs still isn't fully understood. Antidepressants may increase neurotransmitters in the spinal cord that reduce pain signals. But they don't work immediately.

You may feel some relief from an antidepressant after a week or so, but maximum relief may take several weeks. People generally experience moderate pain relief from antidepressants.

Medications from other drug classes with distinct mechanisms of pain relief (such as anticonvulsants) may be used in combination with antidepressant class medications if pain relief with antidepressants is incomplete.

Antidepressants are classified based on their chemical structure and how they work. One of the most effective groups of antidepressants for pain is known as the tricyclics.

Tricyclic antidepressants

Tricyclic antidepressants are the most common type of antidepressant used for pain. They include:

  • Amitriptyline
  • Imipramine (Tofranil)
  • Clomipramine (Anafranil)
  • Doxepin
  • Nortriptyline (Pamelor)
  • Desipramine (Norpramin)
Aug. 22, 2013