What role do antidepressants play in the management of fibromyalgia symptoms?

Antidepressants play a role in the management of fibromyalgia symptoms because fibromyalgia is classified as a type of chronic primary pain NICE NG193. For individuals aged 18 years and over with chronic primary pain, antidepressants such as amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine, or sertraline may be considered NICE NG193. It is important to note that this is an off-label use of these medications for chronic primary pain NICE NG193. When offered, it should be explained that these medicines may help with quality of life, pain, sleep, and psychological distress, even in the absence of a diagnosis of depression NICE NG193. A Cochrane review indicated that duloxetine was moderately efficacious across all outcomes at a standard dose of 60 mg for chronic pain, while evidence for all other antidepressants was of low certainty NICE CKS. NICE guidelines advise against initiating other medications like antiepileptic drugs (including gabapentinoids), antipsychotics, benzodiazepines, non-steroidal anti-inflammatory drugs (NSAIDs), or opioids to manage chronic primary pain NICE NG193. If a person with chronic primary pain is already taking any of these medicines, their prescribing should be reviewed as part of shared decision-making NICE NG193. Specialist advice should be sought if pharmacological management with antidepressants is being considered for young people aged 16 to 17 years NICE NG193. When making shared decisions about stopping antidepressants, discussions should include any problems associated with withdrawal NICE NG193.