Summary: The use of antidepressants for managing chronic pain issues like low back pain and osteoarthritis is increasing at an alarming rate. Even many clinical guidelines recommend their use. However, researchers say that evidence in favor of using these medications mostly comes from industry-sponsored trials. Some of the transparent studies published in recent years did not show much benefit of antidepressants in managing back pain and osteoarthritis.
In the 1960s, antidepressants were regarded as orphan drugs, which are medications that are good for treating some rare conditions. However, over the decades, things have changed incredibly, and now it seems that doctors are using antidepressants to manage many states, not only mood disorders.
Doctors widely prescribe antidepressants for managing pain, neuropathies, headaches, arthritis, low back pain, and more. However, researchers warn that there is insufficient evidence regarding the efficacy of these drugs in many conditions. Moreover, these are highly toxic drugs with many side effects.
CDC data shows that in the last 30 days, 13-14% of adults have used antidepressants, which rises to almost 25% for women older than 60. Remember that these numbers are for the last 30 days, not the year. Yes, these numbers are worrisome, indicating how commonly doctors prescribe these drugs.
It means that most adults would be prescribed antidepressants for various reasons during their lifetime. However, what is worrisome is that they are often prescribed to treat conditions in which these drugs do not seem to work.
Regretfully, many clinical guidelines also recommend using antidepressants for managing pain when other commonly used painkillers fail to help.
One of the new and highly extensive studies failed to show any benefit of antidepressants in back pain and osteoarthritis. These two conditions are the most common causes of chronic pain in middle-aged and older adults. Thus, these conditions are one of the reasons why so many people are being prescribed antidepressants.
The present study was published in the journal BMJ. The study analyzed all the clinical studies regarding the use of antidepressants to manage low back or neck pain, sciatica, and knee or hip osteoarthritis.
This systemic review included 33 randomized clinical trials with a total of 5318 participants. The study found that there was weak evidence that antidepressants like serotonin-noradrenaline reuptake inhibitors (SNRIs) helped reduce back pain. There was even weaker evidence regarding the use of antidepressants for treating osteoarthritis. Similarly, antidepressants do not appear to help with sciatica2.
The study concluded that there appears to be very little benefit from antidepressants in low back pain or osteoarthritis. Furthermore, considering the toxicity of these medications, it would be correct to say that the use of these medications in these conditions is difficult to justify.
Moreover, efficacy is not the only factor to consider. These medications cause nausea, fatigue, mood issues, weight gain, and many other side effects. Long-term harm from these medications could be even more.
Since studies show mild evidence that antidepressants help in these common painful conditions, many guidelines recommend their use. Therefore, it is essential to consider other factors, like many of these clinical trials were industry-funded.
All industry-sponsored clinical studies do not matter how well they were done. They suffer from bias. Even a slight bias can significantly impact the outcomes of clinical studies.
Similarly, there are very few safety studies regarding the long-term use of antidepressants to manage these pains. However, conditions like low back pain or osteoarthritis require prolonged treatment and lifelong use of specific medications.
Therefore, experts think transparent clinical trials without industry interference are urgently needed to understand if antidepressants have any role in managing these chronic painful conditions. It is essential to downgrade all the industry-sponsored clinical studies to understand things.
Even worrisome is the trend of the use of antidepressants in children and young adults. US FDA granted approval for the use of duloxetine in juvenile fibromyalgia. However, the drug can cause serious side effects like hallucinations, suicidal thoughts, and more. The drug manufacturer has intentionally downplayed the risk of such adverse effects.
In summary, antidepressants may not have many roles in managing back pain and osteoarthritis. Moreover, there is a risk of severe side effects from these medications. Currently, most evidence favoring these drugs’ use comes from industry-sponsored clinical trials, which tend to be biased. There is an urgent need for transparent clinical studies to understand the role of antidepressants in various health conditions.
By Gurpreet Singh Padda, MD, MBA, MHP