Selective serotonin reuptake inhibitors (SSRIs) for fibromyalgia

Examples

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Brand Name	Chemical Name
Celexa	citalopram hydrobromide

Brand Name	Chemical Name
Lexapro	escitalopram oxalate

Brand Name	Chemical Name
Prozac	fluoxetine hydrochloride

Brand Name	Chemical Name
Paxil	paroxetine hydrochloride

Brand Name	Chemical Name
Zoloft	sertraline hydrochloride

How It Works

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Experts do not know exactly how SSRIs work to improve fibromyalgia, but some people with fibromyalgia who take SSRIs seem to have improved mood and less fatigue.

These medicines are a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs). Doctors also prescribe them to treat depression.

Why It Is Used

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Doctors may prescribe SSRIs when mood problems are a major symptom of fibromyalgia.

How Well It Works

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SSRIs seem to improve mood and may help relieve pain, fatigue and sleep problems.¹ Some people taking fluoxetine report decreased pain and improved ability to function.² Fluoxetine is the SSRI being studied the most for fibromyalgia.³

Side Effects

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Side effects of selective serotonin reuptake inhibitors (SSRIs) include:

• Nausea, loss of appetite, and diarrhea.
• Anxiety.
• Sleep problems.
• Loss of sexual desire or ability.
• Headaches.
• Weight gain.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

FDA Advisories. 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 at the beginning of treatment or when doses are changed.
• A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.
• A warning about taking triptans, used for migraines, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a serious condition called serotonin syndrome.

What To Think About

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Studies suggest that using a selective serotonin reuptake inhibitor (SSRI) and a tricyclic antidepressant (such as amitriptyline hydrochloride) together may be more successful at breaking the cycle of pain and sleep problems caused by fibromyalgia than using just a single medication.

Treatment with antidepressants does not always relieve symptoms caused by fibromyalgia. Even when the treatment does work, some people may find the side effects of these medicines unacceptable. The dose of an SSRI used to treat fibromyalgia is usually the same as that needed to treat depression.

Using an antidepressant medication to treat fibromyalgia does not mean that the condition is “all in your head.”

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Rao SR, Clauw DJ (2004). The management of fibromyalgia. Drugs of Today, 40(6): 539–554.

2. Bradley LA, Alarcon GS (2005). Fibromyalgia chapter of Miscellaneous rheumatic diseases section. 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.

3. Goldenberg DL, et al. (2004). Management of fibromyalgia syndrome. JAMA, 292(19): 2388–2395.

Credits

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Author	Shannon Erstad, MBA/MPH
Author	Ralph Poore
Editor	Kathleen M. Ariss, MS
Associate Editor	Michele Cronen
Primary Medical Reviewer	Martin Gabica, MD - Family Medicine
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Benjamin Natelson, MD - Neurology, Chronic Fatigue Syndrome
Last Updated	November 10, 2005