Editor's comment: This was a very small observational study. Just 18 patients completed the study and only seven of those were in the group taking antidepressants (five took an SNRI and two took an SSRI). However, the finding that these patients' quality of life worsened when taking antidepressants for a year is concerning – especially since two of the three drugs approved by the FDA for treating fibromyalgia are SNRI antidepressants. Additional larger studies are warranted.
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The Use of Antidepressants in the Long-Term Treatment Should not Improve the Impact of Fibromyalgia on Quality of Life
Background: Antidepressant (AD) drugs are effective in the short term treatment of fibromyalgia (FM). It may be useful to study the long-term impact of AD on patients with FM.
Methods: One-year follow-up study on 23 females with FM divided into groups on AD (ADg-N=7), and not taking AD (NADg-N=11). Evaluation at t1 and at the end (t2) with the Fibromyalgia Impact Questionnaire (FIQ); at t2 with: SCID-IV; Mood Disorder Questionnaire (MDQ); Short Form-12; Hamilton Depression Rating Scale (HAM-D); Functioning Assessment Short Test (FAST)
After a year the AD group showed a worst impact of the disease by FIQ (p=0.017),
worsened quality of life by SF-12 (p<0.01),
and disability linked to bipolar symptoms by FAST (p=0.05).
About 40% of the sample was screened positive at MDQ without difference in the two groups.
The patients who recovered from a depressive episode did not differ between ADg and NADg (20% vs 33.3%), and were fewer than expected from the literature (40-60%).
The HAM-D score at the end of the trial was worse in the ADg (p<0.03).
Limitations: Observational research on few patients, not specifically designed to test the hypothesis. The results have a heuristic value only.
Discussion: The results should be read in the light of the high prevalence of patients screened positive for Bipolar Disorders and of the well-known poor response of the mood symptoms to antidepressants in Bipolar Depression. The deterioration in the long-term management of FM patients following AD treatments suggests the need for new and robust studies.
Source: Clinical Practice and Epidemiology in Mental Health, July 12, 2013. By M.G. Carta,, V. Ruggiero, F. Sancassiani, F. Cutrano, A.R. Manca, M. Peri, A. Fais, and E. Cacace. Dipartimento di Sanità Pubblica e Medicina Clinica e Sperimentale, Università di Cagliari e Center of Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Italy.