Treatment of fibromyalgia with antidepressants: A meta-analysis

Patrick G. O'Malley, Erin Balden, Glen Tomkins, James Santoro, Kurt Kroenke, Jeffrey L. Jackson

Research output: Contribution to journalArticle

308 Citations (Scopus)

Abstract

BACKGROUND: Fibromyalgia is a common, poorly understood musculoskeletal pain syndrome with limited therapeutic options. OBJECTIVE: To systematically review the efficacy of antidepressants in the treatment of fibromyalgia and examine whether this effect was independent of depression. DESIGN: Meta-analysis of English-language, randomized, placebo-controlled trials. Studies were obtained from searching Medline, Embase, and Psyclit (1966-1999), the Cochrane Library, unpublished literature, and bibliographies. We performed independent duplicate review of each study for both inclusion and data extraction. MAIN RESULTS: Sixteen ramdomized, placebo-controlled trials were identified, of which 13 were appropriate for data extraction. There were 3 classes of antidepressants evaluated: tricyclics (9 trials), selective serotonin reuptake inhibitors (3 trials), and S-adenosylmethionine (2 trials). Overall, the quality of the studies was good (mean score 5.6, scale 0-8). The odds ratio for improvement with therapy was 4.2 (95% confidence interval [95% CI], 2.6 to 6.8). The pooled risk difference for these studies was 0.25 (95% CI, 0.16 to 0.34), which calculates to 4 (95% CI, 2.9 to 6.3) individuals needing treatment for 1 patient to experience symptom improvement. When the effect on individual symptoms was combined, antidepressant improved sleep, fatigue, pain, and well-being, but not trigger points. In the 5 studies where there was adequate assessment for an effect independent of depression, only 1 study found a correlation between symptom improvement and depression scores. Outcomes were not affected by class of agent or quality score using meta-regression. CONCLUSION: Antidepressants are efficacious in treating many of the symptoms of fibromyalgia. Patients were more than 4 times as likely to report overall improvement, and reported moderate reductions in individual symptoms, particularly pain. Whether this effect is independent of depression needs further study.

Original languageEnglish
Pages (from-to)659-666
Number of pages8
JournalJournal of General Internal Medicine
Volume15
Issue number9
DOIs
StatePublished - 2000

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Fibromyalgia
Antidepressive Agents
Meta-Analysis
Depression
Confidence Intervals
Placebos
Trigger Points
Pain
Musculoskeletal Pain
S-Adenosylmethionine
Tricyclic Antidepressive Agents
Serotonin Uptake Inhibitors
Bibliography
Therapeutics
Libraries
Fatigue
Sleep
Language
Randomized Controlled Trials
Odds Ratio

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Treatment of fibromyalgia with antidepressants : A meta-analysis. / O'Malley, Patrick G.; Balden, Erin; Tomkins, Glen; Santoro, James; Kroenke, Kurt; Jackson, Jeffrey L.

In: Journal of General Internal Medicine, Vol. 15, No. 9, 2000, p. 659-666.

Research output: Contribution to journalArticle

O'Malley, Patrick G. ; Balden, Erin ; Tomkins, Glen ; Santoro, James ; Kroenke, Kurt ; Jackson, Jeffrey L. / Treatment of fibromyalgia with antidepressants : A meta-analysis. In: Journal of General Internal Medicine. 2000 ; Vol. 15, No. 9. pp. 659-666.
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