Welcome to the continuing series Why You Should See a Pain Management Psychiatrist.  This week we’ll look at using psychiatric medication for pain.

Antidepressants can be used for chronic pain itself, separately from treating depression.  This means they are sometimes prescribed even if someone has no depression – just to treat pain itself.  Let’s look at 3 different categories of antidepressants used to treat pain.

1. SNRI (Serotonin-norepinephrine reuptake inhibitors)

It seems that “dual-action” antidepressants, those that work on both the serotonin and the norepinephrine systems, also help with pain.  An example is Cymbalta, which has been shown to be helpful in both diabetic peripheral neuropathy and fibromyalgia, and the newer medication Savella, which is approved for fibromyalgia.

2. Tricyclics (TCA)

These are older antidepressants and have been shown to help in many different pain disorders.  In fact, they are the most-studied antidepressants for pain.  However, even though they work, they are not FDA-approved to treat pain.  Examples include Amitriptyline (Elavil) and Nortriptyline (Pamelor).

3. SSRI (Selective serotonin reuptake inhibitors)

There is some evidence, thought research has been mixed, that SSRI’s may help with headaches, both migraines and Chronic Daily Headache. 

Overall, antidepressants are sometimes helpful in treating pain itself.   As we know, pain often exists along with depression and anxiety, so these medications might be a good choice when psychiatric symptoms are present along with pain.  Using 1 medication for multiple symptoms is a good idea.

An important point to remember is that if your doctor recommends an antidepressant, it doesn’t mean that your pain is “in your head” or that you’re simply imagining your pain.

Other articles in the series:

1. Why comprehensive treatment works better
2. Benefits of a psychiatric evaluation
3. Treatment of psychiatric symptoms
4. Using psychiatric medications for pain
5. Learning psychological skills
6. Making positive behavioral changes
7. Making positive psychological changes
8. Benefits of supportive therapy
9. Benefits of a pain support group
10. New brain-based treatments