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Minus Muscle Pain; Antidepressants May Take Away Aches

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By By: Marty Munson • • April 1, 1996

A recent study revealed that a combination of antidepressants, amitriptyline plus fluoxetine, helped relieve muscle pain in patients with fibromylagia. The two drugs together worked better than each one separately, and the patients, although not suffering depression, did better on well-being tests.

Nothing wrong with your mood. It's your muscles that hurt. Then why is the doctor prescribing not one but two antidepressants to blunt the pain? Recent research suggests that a combination of antidepressants may sap some of the pain in people with the chronic, deep aches caused by fibromyalgia.

When 19 people with fibromyalgia spent six weeks taking a combination of two antidepressants -- amitriptyline (such as Elavil) and fluoxetine (Prozac) -- they saw greater decreases in pain and in sleep disturbances compared with the six weeks they spent taking each antidepressants alone. (And taking each drug alone or in combination was better than six weeks of a placebo pill.)

On the antidepressants, people with fibromyalgia also scored higher on tests of well-being, according to research presented at the American College of Rheumatology's national scientific meeting in October. No one in the study had been depressed before they entered this trial.

"This study shows that fluoxetine reduces pain, amitriptyline reduces pain, but together, they reduce pain even more," says study author Don L. Goldenberg, M.D., professor of medicine at Tufts University School of Medicine, Boston.

Prior to this study, some doctors already prescribed certain antidepressants to help blunt the pain of fibromyalgia, says Dr. Goldenberg. But now that there's evidence from a clinical trial, more doctors may be confident about treating pain with these medicines.

What's exciting about the use of certain antidepressants is that they're believed to act on central-nervous-system hormones that may short-circuit the pain of this disease. (The doses used in this trial were much less than the mood-altering doses used to treat depression, so the people weren't simply "feeling" better.) "Research suggests that serotonin (a brain chemical) and other similar hormones are involved in the pain of fibromyalgia," he says. Increasing serotonin, which is what these medicines do, might be helping undo the feelings of pain in this disease. If that reasoning proves correct, there's another ray of hope: that antidepressants that are currently being developed could be even more effective in ousting the ache of fibromyalgia.

Copyright * 1996 Rodale Press Inc. Copyright * 1997 Information Access Company.

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