Antipsychotics are among the psychoactive medications that may prove to be of benefit in treating fibromyalgia
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Antipsychotics are among the psychoactive medications that may prove to be of benefit in treating fibromyalgia The commonly used options for treating fibromyalgia do not adequately address all of the symptoms, and alternative options are needed. Limited data suggest that antipsychotics and other psychoactive agents may provide some benefit, although more studies are required.
(norepinephrine) reuptake inhibitors (SNRIs). Published data for amitriptyline are not available beyond a 3-month treatment period,[6] although the SNRIs duloxetine[7] and milnacipran[8] have both shown efficacy for up to 1 year.[1]
y or antiepileptics
Pain only part of the problem The prominent feature of fibromyalgia is chronic generalized musculoskeletal pain with no apparent cause.[1] However, fibromyalgia can also involve any combination of other symptoms (with frequency and/or severity that can change over time), such as sleep disturbances, fatigue, stiffness, balance problems, cognitive difficulties, depression and anxiety. In addition, fibromyalgia is often associated with co-morbidities, including chronic headache, irritable bowel syndrome, major depression, anxiety disorders, chronic fatigue syndrome, systemic lupus erythematosus or rheumatoid arthritis.[1] This article summarizes the available evidence for treating fibromyalgia with various psychoactive drugs, as reviewed by Calandre and Rico-Villademoros.[1] While it remains controversial whether fibromyalgia is a distinct clinical entity to ‘functional’ illnesses, the need to effectively treat patients is undisputed.[1] However, there is ongoing debate over which approaches should be used to treat this condition. Guidelines[2-4] generally recommend a combination of multi-modal approaches, consisting of both non-pharmacological (table I) and pharmacological (table II) strategies individualized to each patient’s needs.[1]
Treat pain with antidepressants ... Antidepressants are the most commonly used drugs to treat neuropathic and non-neuropathic chronic pain, including fibromyalgia.[1] In general, antidepressants reduce pain, sleep disturbances, fatigue and depressed mood, and improved health-related quality of life (HR-QOL) in patients with fibromyalgia.[5] Furthermore, two of the drugs approved in the US to treat fibromyalgia (duloxetine and milnacipran) are antidepressants (table II). Tricyclic antidepressants (TCAs), in particular amitriptyline, are some of the oldest drugs used to treat fibromyalgia.[1] A meta-analysis[5] reported the greatest effect sizes for pain reduction with TCAs compared with selective serotonin reuptake inhibitors and serotonin-noradrenaline Drugs Ther Perspect 2012; Vol. 28, No. 11
Pregabalin and gabapentin (table II) bind to the a2d ligand subunit of voltage-gated calcium channels, which dampens the release of excitatory neurotransmitters.[1] Although both drugs have been shown to be effective in treating neuropathic pain, only pregabalin has been thoroughly investigated for the treatment of fibromyalgia (approved in the US in this indication). Bo
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