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Depression Medication for Chronic Pain

Types of Antidepressants Used to Treat Chronic Pain


Updated June 26, 2014

Antidepressants are adjuvant analgesics -- medications that can effectively treat pain even though they are designed for another purpose. While it might seem strange to be prescribed a depression medication for your pain, especially if you do not have any signs of depression, it is not unusual for doctors to recommend antidepressants for certain types of chronic pain.

Depression medication is not effective for all types of chronic pain. In general, it isn’t used for chronic muscular aches and pains. However, depression medication can effectively control some types of neuropathic pain, as well as pain syndromes like fibromyalgia or central pain syndrome. Depression medication is sometimes used to treat chronic headaches, such as migraines or tension headaches.

The most commonly used depression medications for chronic pain are tricyclic antidepressants (TCAs). However, selective serotonin reuptake inhibitors (SSRIs), and a few other select types are also effective against some types of chronic pain. Because people respond differently to depression medications, and because each chronic pain condition is unique, it may take several tries before you find the depression medication that works for you.

Tricyclic Antidepressants

Tricyclic antidepressants, or TCAs, are depression medications that interfere with the transmission of serotonin and norepinephrine at nerve endings. This is thought to strengthen the body’s natural pain inhibition system. In other words, it changes the way pain is perceived at the level of the nerves. Some TCAs have sedative properties as well, which may help regulate sleep.

TCAs are traditionally the main kind of depression medication used to treat chronic pain, and are effective against neuropathic pain, pain syndromes and chronic headaches. Some of the most common TCAs used for chronic pain include:

  • Amitriptyline
  • Nortriptyline
  • Desipramine
  • Imipramine
  • Doxepin
  • Trimipramine
  • Clomipramine

Potential side effects of TCAs include blurry vision, difficulty with urination or constipation, dry mouth, fatigue and weight gain.

Selective Serotonin Reuptake Inhibitors

Selective Serotonin Reuptake Inhibitors, or SSRIs, are depression medications that work in a similar way as TCAs. SSRIs primarily inhibit transmission of serotonin at nerve endings. Though they are thought to have fewer unpleasant side effects than the TCA depression medications, SSRIs are generally not as effective at treating neuropathic pain. They do, however, can help with certain types of chronic headaches and some pain syndromes.

Some common SSRIs for chronic pain include:

  • Citalopram
  • Escitalopram
  • Fluoxetine
  • Fluvoxamine
  • Paroxetine
  • Sertraline

Potential side effects of SSRI depression medications include decreased appetite and nausea, dry mouth, tremors, fatigue or drowsiness, increased heart rate and blood pressure and sexual problems.

Serotonin and Norepinephrine Reuptake Inhibitors

Serotonin and Norepinephrine Reuptake Inhibitors, or SNRIs, are newer depression medications that are used to treat some types of chronic pain. Like TCAs, SNRIs also inhibit serotonin and norepinephrine, though they work in a slightly different way. They are thought to have fewer side unpleasant effects than both TCAs and SSRIs, and may be effective against neuropathic pain and certain pain syndromes.

Some common SNRIs for chronic pain include:

  • Duloxetine
  • Venlafaxine
  • Mirtazapine

Potential side effects of SNRI depression medications include nausea, fatigue and dizziness.

Other Antidepressants

A few other depression medications may also be effective at treating chronic neuropathic pain, including dopamine-norepinephrine reuptake inhibitors and serotonin receptor modulators.

Some other common depression medications used for chronic pain include:

  • Bupropion
  • Nefazodone
  • Trazodone

Will Depression Medication Control My Chronic Pain?

It might. Depression medications, when taken as directed, can keep many types of chronic pain under control. Depression medication is commonly used to treat the following chronic pain conditions:

  • Peripheral neuropathy (diabetic neuropathy)
  • Postherpic neuralgia (pain from shingles)
  • Migraines
  • Tension headaches
  • Fibromyalgia
  • Central pain syndrome

Depression medication also may be used to treat depression associated with chronic pain, as many people suffer from both. You may be prescribed an antidepressant even if you have a musculoskeletal condition like back pain or arthritis, simply to control your depression symptoms. This can help alleviate the intensity of chronic pain.

Is Depression Medication Enough?

Many people who use depression medication for chronic pain also may use other painkillers to treat everyday aches and pains or breakthrough pain. Depending on the type of depression medication you take, you may also be instructed to take NSAIDs or acetaminophen as needed.


American Chronic Pain Association. APCA Medications and Chronic Pain: Supplement 2007. Accessed 6/21/09. http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

Maizels, Morris and McCarberg, Bill. Antidepressants and Antiepileptic Drugs for Chronic Non-Cancer Pain. American Family Physician. 2005;71:483-90

Sansone, Randy A and Sansone Lori A. Pain, Pain Go Away: Antidepressants and Pain Management. Psychiatry. 2008;5(12):16–19

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