Antidepressants have different adverse effect profiles when used for chronic pain

Researchers say that better knowledge of the side effects of low-dose antidepressants is needed to aid the selection of drugs for patients

Nortriptyline capsules

Low-dose antidepressants are widely used in the treatment of chronic pain, but their adverse event and tolerability profiles are less established in this group of patients.

Researchers carried out a systematic review and meta-analysis of 33 papers, published between 1995 and 2015, and 23 studies to analyse the adverse events of the most commonly used antidepressants in chronic pain.

The researchers found that all antidepressants, except nortriptyline, had a higher rate of adverse events compared with placebo, with the most common being dry mouth, dizziness and nausea. Risk for withdrawal due to adverse effects was highest in desipramine, followed by milnacipran, venlafaxine and duloxetine.

Each antidepressant had a distinct adverse effect profile that differed from that of higher doses of the same drugs given for depression.

Writing in Frontiers in Neurology (14 July 2017), the researchers suggested that better knowledge of these profiles could aid the selection of antidepressant for individual patients based on their comorbidities and concurrent medications[1]


[1] Riediger C, Schuster T, Barlinn K et al. Adverse effects of antidepressants for chronic pain: a systematic review and meta-analysis. Front Neurol 2017; doi: 10.3389/fneur.2017.00307

Last updated
Clinical Pharmacist, CP, December 2017, Vol 9, No 12;9(12):DOI:10.1211/PJ.2017.20203866

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