At first glance, you may think this section is in the wrong chapter. How can taking prescription antidepressants help with pain? Actually, antidepressants can help decrease chronic pain in several ways. The two most obvious ways are i Improved sleep so pain decreases i Decreased depression, which is a common side effect of chronic pain (Check out Chapter 15 for more information about depression and your emotions.)
However, there's much more to this story. Many studies have shown that some classes of antidepressants have analgesic properties and have reduced chronic pain in more than 50 percent of the people studied.
The antidepressants that have been studied the most for pain relief are tri-cyclic antidepressants. These antidepressants may work on pain by
^ Blocking pain pathways
^ Increasing endorphin release (Endorphins help regulate mood and block pain.)
Some of the most common tricyclic antidepressants (and their brand names)
^ Amitriptyline hydrochloride (Amitril, Elevil, Endep) ^ Desipramine (Norpramin) ^ Doxipin hydrochloride (Sinequan) ^ Imipramine hydrochloride (Janimine, Tofranil) ^ Nortriptyline (Aventyl, Pamelor)
Dosages for pain relief are often lower than dosages for treatment of depression. The drug may take several weeks to be effective, so don't be ready to give up if you don't see any results within the first week or two.
Antidepressants do have side effects. Check out Chapter 15 for more information.
What about other antidepressants not in the tricyclic family? A number of newer antidepressant drugs on the market fall into categories that are nearly unpronounceable. Three new categories are
^ Serotonin and Noradrenergic Reuptake Inhibitors (SNaRI), like venlafax-ine and duloxetine
^ Noradrenergic and Specific Serotoninergic Antidepressants (NaSSA), like mirtazapine (Remeron)
^ Noradrenaline Reuptake Inhibitors (NaRI), like reboxetine
SNaRI antidepressants are some of the most investigated of the new drugs shown to be effective in the treatment of different kinds of pain, and appear to have fewer side effects than TCAs. Duloxetine (Cymbalta) and venlafaxine (Effexor) have both been found to be effective in treating chronic pain. Mirtazapine (Remeron) is an NaSSA that is more sedating than some of the other antidepressants and may be helpful if you're having trouble sleeping.
Selective Seratonin Reuptake Inhibitors (SSRIs) are useful for relieving neuropathic pain. Citalopram (Celexa), fluvoxamine (Luvox), paroxitene (Paxil), fluoxetine (Prozac), and sertraline (Zoloft) are all SSRIs. See Chapter 15 for more on antidepressants and their effects.
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