Antidepressant Medication and Chronic Pain

By: Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

Not everyone with chronic pain and depression will need antidepressant medications. However, this class of medication may be indicated for several reasons; one is that many people living with chronic pain disorders become clinically depressed. The Addiction-Free Pain Management™ system suggests a full biopsychosocial evaluation to determine the severity of the problem before any medications are prescribed.

Situational depression responds best to cognitive behavioral therapy and in those cases medications are not necessary. Other types (bipolar) may need a medical intervention in addition to psychotherapy. There are many different types or classifications of antidepressants to choose from, therefore a specialist should be consulted to determine the most effective medication for each person.

Pain reduction is another key factor to consider using an antidepressant. For example the use of tricyclic antidepressants has been an effective tool in pain management for years. The tricyclic medication Elavil (amitriptyline) is frequently used to treat and help prevent migraine headaches. These antidepressants have been able to provide relief for nerve pain and often result in lowering the dose of opiate medications. Since sleep disturbances often accompany both chronic pain and depression some healthcare providers use this type of medication as a sleep aid.

Another class of newer antidepressants is the SSRIs (selective serotonin reuptake inhibitors). Many pain management specialists utilize this type of medication for chronic pain treatment particularly for people who live with constant debilitating chronic pain, as their serotonin system becomes depleted. This type of medication is good for both depression as well as improving pain management.

SSRIs like Prozac, Effexor, Lexapro, or Celexa, improve mood as well as help relieve pain, reduce fatigue and improve sleep problems. There have been reports about SSRIs being helpful for some types of neuropathic pain symptoms. Some studies also suggest that using an SSRI and a tricyclic antidepressant (such as amitriptyline) together may be more successful at breaking the cycle of pain, depression, and sleep problems caused by fibromyalgia than using just either one alone.

In addition, these three antidepressant medications can also be very helpful; Cymbalta and Effexor, which block the reuptake of serotonin and norepenepherine and Wellbutrin, which alters the levels of norepenepherine and dopamine. Cymbalta is a versatile medication that is FDA approved to treat depression and certain types of neuropathic pain. Norepenepherine, serotonin, and dopamine are neurotransmitters that not only affect depression but also pain management. Many pain management specialists recognize that combining different medications creates a synergistic effect for both pain management and improving depression.

The good news is that there are many different management and treatment options for depression. Try to remember that overcoming depression can take time and someone living with chronic pain and depression will need to stay strong and focused when faced with tough pain days. They will also need to reach out for support to keep them from becoming isolated. The important thing to remember is that overcoming depression is achievable with the right team and the right plan!