Antidepressants are commonly used worldwide to treat pain.
But in a new study, researchers found these drugs offer little to no help for people suffering chronic back pain and osteoarthritis and may even cause harm.
The research was conducted by a team from the University of Sydney.
Back pain and knee osteoarthritis affect millions of people globally and are leading causes of disability.
When first-line pain medications such as paracetamol and ibuprofen fail to improve symptoms, many people are prescribed antidepressants for their pain.
Most clinical practice guidelines recommend antidepressants for long term (chronic) back pain and hip and knee osteoarthritis, yet evidence supporting their use is uncertain.
In the study, the team examined the efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis compared with placebo.
They reviewed 33 clinical trials with more than 5,000 participants with low back or neck pain, sciatica, or hip or knee osteoarthritis.
The trials tested 6 classes of antidepressants including serotonin-noradrenaline reuptake inhibitors (SNRIs) and tricyclic antidepressants.
The researchers found that for back pain the antidepressants were either ineffective or provided a very small effect, which was unlikely to be perceived as worthwhile by most patients.
For people with osteoarthritis, effects were still small, but could be potentially perceived as worthwhile by some patients.
The team says it is concerning as some antidepressants significantly increase the risk of a person experiencing adverse events.
Many people are being treated with these medications that may not be helping their pain and may be doing them harm.
The researchers strongly advise those currently taking antidepressants for treating back pain and osteoarthritis not to abruptly cease treatment with antidepressant medicines but to consult with their doctor.
This can lead to withdrawal effects which can be distressing and sometimes present as serious health issues.
These withdrawal effects include dizziness, nausea, anxiety, agitation, tremor, sweating, confusion and sleep disturbance.
One author of the study is Dr. Giovanni Ferreira, a postdoctoral research fellow at the Institute for Musculoskeletal Health.
The study is published in BMJ.
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