Serotonin and norepinephrine reuptake inhibitors (SNRIs) for fibromyalgia

Examples

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Brand Name	Chemical Name
Cymbalta	duloxetine

Brand Name	Chemical Name
Effexor	venlafaxine

How It Works

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SNRIs work to increase the activity of brain chemicals called serotonin and norepinephrine. Doctors do not know exactly how this improves fibromyalgia symptoms.

Why It Is Used

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Doctors may prescribe SNRIs when mood problems are a major symptom of fibromyalgia. SNRIs are also used for people without fibromyalgia who have depression.

How Well It Works

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Some people with fibromyalgia who take SNRIs notice an improvement in a number of symptoms, including depression, pain, and fatigue.¹

Side Effects

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Side effects of serotonin and norepinephrine reuptake inhibitors (SNRIs) can include:

• Cough and sore throat.
• Nausea and loss of appetite.
• Problems with bowel movements.
• Sleep problems.
• Loss of sexual desire or ability.
• Weight loss.
• Dilated pupils.

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

FDA Advisory. 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 the doses are changed.

The FDA has also issued 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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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.

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. 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