Selective serotonin reuptake inhibitors (SSRIs) for fibromyalgia

Examples

Generic Name	Brand Name
citalopram	Celexa
escitalopram	Lexapro
fluoxetine	Prozac
paroxetine	Paxil
sertraline	Zoloft

How It Works

Experts do not know exactly how SSRIs work to improve fibromyalgia. But some people with fibromyalgia who take SSRIs seem to have improved mood and less fatigue.

These medicines are a type of antidepressant. Doctors also prescribe them to treat depression.

Why It Is Used

Doctors may prescribe SSRIs when mood problems are a major symptom of fibromyalgia.

How Well It Works

SSRIs seem to improve mood and may help relieve pain, fatigue and sleep problems.¹ Some people taking fluoxetine report decreased pain and improved ability to function.²

Side Effects

Side effects of selective serotonin reuptake inhibitors (SSRIs) include:

• Nausea, loss of appetite, and diarrhea.
• Anxiety.
• Sleep problems.
• Loss of sexual desire or ability.
• Headaches.
• Weight gain.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
• A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.
• A warning about taking triptans, used for headaches, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.

What To Think About

Studies suggest that using a selective serotonin reuptake inhibitor (SSRI) and a tricyclic antidepressant (such as amitriptyline hydrochloride) together may be more successful at breaking the cycle of pain and sleep problems caused by fibromyalgia than using just a single medicine.

Treatment with antidepressants does not always relieve symptoms caused by fibromyalgia. Even when the treatment does work, some people may find the side effects of these medicines unacceptable. The dose of an SSRI used to treat fibromyalgia is usually the same as that needed to treat depression.

Using an antidepressant medicine to treat fibromyalgia does not mean that the condition is "all in your head."

Studies have found that daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Talk to your doctor about this risk before taking an SSRI.³

SSRIs make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.⁴

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Author:	Shannon Erstad, MBA/MPH	Last Updated: October 30, 2007
Medical Review:	Anne C. Poinier, MD - Internal Medicine Stanford M. Shoor, MD - Rheumatology
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