Depression is a common accompaniment of
pain, particularly when
pain is unremitting. The use of a variety of
antidepressant medications is associated with
pain reduction, an effect that is independent of the mood-enhancing qualities of these drugs. This
pain relief is a consequence of a wide variety of actions of
antidepressants on the neuroregulatory mechanisms associated with pain perception and transmission. The older
tricyclic antidepressants (TCAs) and the newer 'balanced' reuptake inhibitors (such as
duloxetine) seem to be more efficacious in terms of providing
pain relief than the
selective serotonin reuptake inhibitors (
SSRIs). Unfortunately, adverse effects are not uncommon during
antidepressant use, particularly with TCAs. It is now becoming apparent that TCAs can have an
analgesic effect when applied topically and that this effect is produced by peripheral mechanisms rather than systemic uptake.
Antidepressants remain a major therapeutic tool in the management of chronic
pain.