RESEARCH - Treatment of fibromyalgia with antidepressants: a meta-analysis

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J Gen Intern Med. 2000 Sep;15(9):659-66.

Treatment of fibromyalgia with antidepressants: a meta-analysis.

O'Malley PG, Balden E, Tomkins G, Santoro J, Kroenke K, JL.

Division of General Internal Medicine, Walter Army Medical Center

Washington, DC, USA.

BACKGROUND: Fibromyalgia is a common, poorly understood musculoskeletal pain

syndrome with limited therapeutic options. OBJECTIVE: To systematically

review the efficacy of antidepressants in the treatment of fibromyalgia and

examine whether this effect was independent of depression. DESIGN:

Meta-analysis of English-language, randomized, placebo-controlled trials.

Studies were obtained from searching MEDLINE, EMBASE, and PSYCLIT

(1966-1999), the Cochrane Library, unpublished literature, and

bibliographies. We performed independent duplicate review of each study for

both inclusion and data extraction. MAIN RESULTS: Sixteen randomized,

placebo-controlled trials were identified, of which 13 were appropriate for

data extraction. There were 3 classes of antidepressants evaluated:

tricyclics (9 trials), selective serotonin reuptake inhibitors (3 trials),

and S-adenosylmethionine (2 trials). Overall, the quality of the studies was

good (mean score 5.6, scale 0-8). The odds ratio for improvement with

therapy was 4.2 (95% confidence interval [95% CI], 2.6 to 6.8). The pooled

risk difference for these studies was 0.25 (95% CI, 0.16 to 0.34), which

calculates to 4 (95% CI, 2.9 to 6.3) individuals needing treatment for 1

patient to experience symptom improvement. When the effect on individual

symptoms was combined, antidepressants improved sleep, fatigue, pain, and

well-being, but not trigger points. In the 5 studies where there was

adequate assessment for an effect independent of depression, only 1 study

found a correlation between symptom improvement and depression scores.

Outcomes were not affected by class of agent or quality score using

meta-regression.

CONCLUSION: Antidepressants are efficacious in treating many of the symptoms

of fibromyalgia. Patients were more than 4 times as likely to report overall

improvement, and reported moderate reductions in individual symptoms,

particularly pain. Whether this effect is independent of depression needs

further study.

PMID: 11029681

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

1029681

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Mayo Clinic in Rochester

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s Hopkins Medicine

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