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Comparative Efficacy of Newer Antidepressants in Combination with Pregabalin for Fibromyalgia Syndrome: A Controlled, Randomized Study.

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Editor’s Note: Anti-depressants are often used as one line of medication treatment for fibromyalgia, and some patients find relief when prescribed a combination of medications.  This study reviewed the impact on somatic symptoms and depression in fibromyalgia patients by combining Lyrica and Paxil as compared to other, older anti-depressants. 

Somatic symptoms (i.e., pain, fatigue, something just isn’t right with our body) are what drive many of us to the doctor in the first place, and depression is a common companion.  Based on two specific measures, this study concludes that combining these two medications can offer some relief from the physical and depressive symptoms of fibromyalgia.  Most importantly, the study suggests enhanced quality of life.

Medications Reviewed

  • Pregabalin, a nerve pain medication, is known by the brand name Lyrica.

  • Paroxetine is a selective serotonin reuptake inhibitor (SSRI) anti-depressant known by the brand names Paxil, Pexeva, and Brisdelle.  

  • Amitriptyline (Elavil) is an anti-depressant and nerve pain medication.  

  • Venlafaxine (Effexor) is an anti-depressant and nerve pain medication.

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Abstract
 
BACKGROUND
 
This controlled, randomized study investigated the hypothesis that the combined use of pregabalin plus paroxetine for fibromyalgia management would be associated with comparable Somatic Symptoms Scale-8 (SSS-8) and Center for Epidemiological Studies Depression Scale (CESDS) scores, but higher tolerability than the combined use of pregabalin plus either amitriptyline or venlafaxine.
 
METHODS
 
After institutional ethics committee approval, 75 female subjects diagnosed with fibromyalgia and in receipt of pregabalin (75 mg/day) were randomly allocated to concurrently receive amitriptyline (25 mg/day; n = 24), venlafaxine (75 mg/day; n = 25), or paroxetine (25 mg/day; n = 26). All patients were assessed bimonthly for 6 consecutive months for changes in SSS-8 and CESDS scores, life satisfaction, mood, sleep quality, fatigue, medication tolerability, and adverse events.
 
RESULTS
 
Compared with pregabalin plus amitriptyline or venlafaxine, the combined use of pregabalin plus paroxetine in fibromyalgia patients resulted in significantly lower SSS-8 and CESDS scores from 18 (P < 0.05) and 10 weeks (P < 0.001) after the initiation of study medications, respectively; higher medication tolerability (P < 0.001); improved life satisfaction, mood, and sleep quality at most observation times (P < 0.05); and fewer instances of dry mouth and elevated blood pressure (P < 0.02). Medication termination due to poor tolerability was observed most frequently in the venlafaxine group (P < 0.05), while drowsiness, dizziness, blurred vision, abnormal taste, hunger, hallucination, urination problems, and sexual dysfunction were observed most frequently in the amitriptyline group (P < 0.02).
 
CONCLUSION
 
The combined use of pregabalin plus paroxetine offers an effective method with increased tolerability to reduce the somatic and depressive symptoms of fibromyalgia and to enhance the quality of life in affected individuals.
  
Reference:  Ramzy EA, Comparative Efficacy of Newer Antidepressants in Combination with Pregabalin for Fibromyalgia Syndrome: A Controlled, Randomized Study. Pain Pract. 2016 Feb 19. doi: 10.1111/papr.12409. [Epub ahead of print]


 
Disclaimer: This material is posted for informational and educational purposes only and is not intended to substitute for medical or other professional advice. Consult your physician or other health care provider regarding your symptoms.

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