Tricyclic Antidepressants for Fibromyalgia
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How It Works
Experts do not know exactly how tricyclic antidepressants improve symptoms of fibromyalgia. They may help some people with fibromyalgia to sleep better through the night by increasing the deep phase of sleep and decreasing muscle spasms.1
Why It Is Used
Doctors may prescribe tricyclic antidepressants when sleep problems are a major symptom of fibromyalgia.
How Well It Works
Some research shows that tricyclics may work better than other antidepressants for treating fibromyalgia symptoms. They are good at helping with sleep problems. But they may become less effective over time.2
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Call 911 or other emergency services right away if you have:
- Trouble breathing.
- Swelling of your face, lips, tongue, or throat.
Call your doctor right away if you have:
- Thoughts of suicide.
- Agitation and restlessness.
- Fast heartbeat.
- Nausea and vomiting.
Common side effects of this medicine include:
- Dry mouth.
- Weight gain.
FDA advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important when treatment begins or when the doses are changed.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Never suddenly stop taking TCAs. The use of any antidepressant should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medicines can cause negative side effects or a relapse of your condition.
TCAs are started at low doses, and the dose is increased gradually to reduce the severity of side effects. You may need regular blood tests to check the amount of the medicine in your blood. Too much of this type of medicine in the bloodstream can be dangerous.
You may start to feel better in 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines or if you do not notice any improvement by 3 weeks, talk to your doctor.
Studies suggest that using the combination of a tricyclic antidepressant and a selective serotonin reuptake inhibitor (SSRI), such as fluoxetine (Prozac), may be more successful at breaking the cycle of pain and sleep problems caused by fibromyalgia than using just a single medicine.
Using an antidepressant medicine to treat fibromyalgia does not mean that the condition is "all in your head." The dose of a tricyclic antidepressant used to treat fibromyalgia is usually much less than that needed to treat depression.
People who have seizures (epilepsy), difficulty urinating (urinary retention), glaucoma (an eye disease), or heart conditions may notice that tricyclic antidepressants make these symptoms worse.
Be sure to tell your doctor about all the medicines you are currently taking. TCAs can interact poorly with certain heart medicines—digoxin (for example, Lanoxin)—and/or with other medicines, such as those used to treat seizures—phenytoin (Dilantin).
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
- Bradley LA, Alarcon GS (2005). Fibromyalgia section of Miscellaneous rheumatic diseases. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 1869–1910. Philadelphia: Lippincott Williams and Wilkins.
- Goldenberg DL, et al. (2004). Management of fibromyalgia syndrome. JAMA, 292(19): 2388–2395.
Last Revised: May 14, 2012
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