[Note: paroxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant. A previous trial by Patkar, et al. reported that most Fibromyalgia patients in a group with no current depressive or anxiety disorders who took time release paroxetine (trade name Paxil) achieved improvements in overall FM impact of 25% or more.]
Background: Despite a high comorbidity of depressive and/or anxiety disorders with fibromyalgia, information on the clinical implications of this comorbidity is limited; but antidepressants are commonly prescribed to treat fibromyalgia in clinical practice. We investigated whether a history of depressive and/or anxiety disorders was associated with response to paroxetine controlled release (CR) in the treatment of fibromyalgia.
Methods: One hundred sixteen (116) fibromyalgia subjects were randomized to receive paroxetine CR or placebo for 12 weeks. The primary outcome was treatment response defined as a 25% or greater reduction in the Fibromyalgia Impact Questionnaire (FIQ) score. In multivariate logistic regression, we determined if a history of depression and/or anxiety disorders was an independent predictor of response to paroxetine CR.
Results: In logistic regression:
• The history of depression and/or anxiety did not predict treatment response as measured by a 25% or greater reduction in Fibromyalgia Impact Questionnaire (FIQ) score (OR=0.66, 95% CI=.29-1.49, Wald=0.97, p=0.32),
• While the drug status (paroxetine CR) was significantly associated with treatment response (OR=2.57, CI=1.2-5.61, Wald=5.5, p=0.02).
Conclusion: A significant proportion of patients with fibromyalgia had a history of anxiety and or depressive disorders. However response to treatment of fibromyalgia symptoms with paroxetine CR was not associated with a history of depressive and/or anxiety disorders. Our findings need to be confirmed in more adequately-powered and well-designed subsequent studies.
Source: Progress in Neuro-psychopharmacology & Biological Psychiatry, May 8, 2009. PMID: 19433129, by Pae CU, Masand PS, Marks DM, Krulewicz S, Peindl K, Mannelli P, Patkar AA. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, South Korea. [E-mail: Ashwin Patkar, Duke University, firstname.lastname@example.org]