Can depression drugs help treat chronic pain?

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Antidepressants, typically associated with treating depression, are gaining recognition for their potential to alleviate chronic pain conditions.

Chronic pain affects a substantial portion of the population, with limited or unknown benefits from commonly used pain medications.

An international team of researchers has conducted a comprehensive review, shedding light on the effectiveness and safety of using antidepressants to manage chronic pain.

Published in The BMJ, this study explores how certain classes of antidepressants can provide relief for various pain conditions, emphasizing the need for clinicians to consider all available evidence before prescribing antidepressants for pain management.

Chronic Pain: A Global Challenge

Chronic pain is a prevalent issue both in Australia and worldwide, impacting one in five people. It often leads to suboptimal treatment outcomes, leaving many individuals without satisfactory relief.

Commonly prescribed pain medications frequently fall short in addressing chronic pain effectively. Amid this challenge, the study investigates whether antidepressants can offer a viable solution.

The ATLANTIS Review: Uniting Existing Evidence

The researchers conducted the ATLANTIS review, which represents the most extensive examination of the safety and effectiveness of antidepressants in treating chronic pain.

The review meticulously analyzed 26 systematic reviews spanning from 2012 to 2022, involving over 25,000 participants.

It encompassed data from eight classes of antidepressants and 22 distinct pain conditions, including back pain, fibromyalgia, headaches, postoperative pain, and irritable bowel syndrome.

Effective Antidepressants for Chronic Pain

The findings revealed that certain antidepressants, particularly serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine, exhibited effectiveness in managing various pain conditions.

These conditions included back pain, knee osteoarthritis, postoperative pain, fibromyalgia, and neuropathic pain (nerve pain). SNRIs proved to be promising solutions for these ailments.

Uncertainty Surrounding Tricyclic Antidepressants

In contrast, the review cast doubt on the efficacy of tricyclic antidepressants, such as amitriptyline, which are commonly used in clinical practice to address pain.

The research suggests that it remains unclear whether these antidepressants are effective or provide any relief for most pain conditions.

A Nuanced Approach to Prescribing Antidepressants for Pain

While the use of antidepressants for pain management is gaining attention globally, the ATLANTIS review advocates for a nuanced approach.

It argues that clinicians should carefully consider the evidence before prescribing specific antidepressants for various pain conditions.

Not all antidepressants exhibit the same level of effectiveness, and a one-size-fits-all approach may not be suitable.

Balanced Decision-Making for Pain Management

Co-author Dr. Christina Abdel Shaheed emphasizes that the review’s findings empower both clinicians and patients to weigh the benefits and potential risks of using antidepressants to manage their pain.

Informed decisions can be made based on the specific pain condition and the evidence regarding the chosen antidepressant’s effectiveness.

Exploring Alternative Pain Management

The ATLANTIS review underscores that pain management should encompass multiple treatment options. Antidepressants, while offering potential benefits, should not be seen as the sole solution.

Other approaches, including exercise, physiotherapy, and lifestyle adjustments, may also play crucial roles in managing chronic pain.

Patients are encouraged to consult with healthcare professionals to explore alternative strategies suitable for their specific needs.


The ATLANTIS review provides a comprehensive overview of the role of antidepressants in chronic pain management.

It offers valuable insights for clinicians and patients alike, emphasizing the importance of informed decision-making when considering antidepressants for pain relief.

As chronic pain continues to challenge individuals worldwide, a nuanced and evidence-based approach to treatment can significantly improve the quality of life for those affected by this condition.

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The research findings can be found in The BMJ.

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