Antidepressants have limited benefit for back and osteoarthritis pain and could cause harm, a study in the BMJ has concluded (20 January 2021).
Researchers carried out a systematic review and meta-analysis of 33 randomised controlled trials comparing the efficacy and/or safety of antidepressants for lower back or neck pain, sciatica, or hip and knee osteoarthritis.
They found moderate certainty evidence that serotonin-norepinephrine reuptake inhibitors (SNRIs) reduced back pain for up to three months, but the effects were unlikely to be clinically important for most patients.
For osteoarthritis, moderate certainty evidence meant that a small beneficial effect of SNRIs for up to three months could not be ruled out.
Low certainty evidence showed that other antidepressants, including tricyclic antidepressants (TCAs), were ineffective for back pain and related disability, but the evidence for either TCAs or SNRIs in people with sciatica was not certain enough to draw firm conclusions.
Furthermore, in the small number of studies looking at safety, SNRIs significantly increased the risk of adverse events.
“We have shown that the benefit of antidepressants for back pain and osteoarthritis appears to be very limited,” said Giovanni Ferreira, a postdoctoral research fellow at the University of Sydney and lead author on the study.
“Even for those who have not responded to other analgesic medicines, antidepressants may not be the answer.”
- 1Ferreira GE, McLachlan AJ, Lin C-WC, et al. Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis. BMJ 2021;:m4825. doi:10.1136/bmj.m4825