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Antidepressants associated with improvements in fibromyalgia symptoms
A meta-analysis published in the Journal of the American Medical Association demonstrated an association between antidepressants and improvements in pain, depression, fatigue, sleep, and health-related quality of life (HRQOL) in patients with fibromyalgia syndrome (FMS).
A meta-analysis published in the Journal of the American Medical Association demonstrated an association between antidepressants and improvements in pain, depression, fatigue, sleep, and health-related quality of life (HRQOL) in patients with fibromyalgia syndrome (FMS).
For this meta-analysis, the investigators screened entries from Medline (1966 through August 2008), PsycINFO (1966 through August 2008), Scopus (1980 through August 2008), and the Cochrane Library (1993 through August 2008). Studies were eligible if they used recognized criteria to define FMS, were randomized and controlled, and included antidepressants (tricyclic and tetracyclic antidepressants [TCAs], selective serotonin reuptake inhibitors [SSRIs], serotonin and noradrenaline reuptake inhibitors [SNRIs], or monoamine oxidase inhibitors [MAOIs]) as a treatment arm. Outcome measures included pain, fatigue, sleep, depressed mood, and HRQOL.
A total of 18 studies were included in the meta-analysis. Across these studies, reductions in pain (standardized mean difference [SMD], –0.43; 95% CI, –0.55 to –0.30; P.001), fatigue (SMD, –0.13; 95% CI, –0.26 to –0.01; P=.04), and depressed mood (SMD, –0.26; 95% CI, –0.39 to –0.12; P.001) were observed in antidepressant-treated patients versus placebo-treated patients. Improvements in sleep (SMD, –0.32; 95% CI, –0.46 to –0.18; P.001) and HRQOL (SMD, –0.31; 95% CI, –0.42 to –0.20; P.001) were also observed in the antidepressant group versus the placebo group. The effect of antidepressants was negligible for the outcome of fatigue and small for other outcomes.
Among antidepressant classes, TCAs were associated with significant improvements in pain (P.001), fatigue (P=.003), and sleep (P.001) outcomes. SSRIs were associated with improvements in pain (P=.04). SNRIs were associated with improvements in pain (P.001) and sleep (P.001) outcomes. MAOIs were associated with improvements in pain (P=.03). The authors stated that the results of this meta-analysis were not sufficient to demonstrate the superiority of 1 class of antidepressants over another.
The investigators discussed several limitations of their study. Because demographics, comorbidities, and comedication use of study patients were not reported, these factors may introduce a source of heterogeneity. Additionally, 6 published randomized, controlled trials were excluded from the study because the published data were not sufficient for the purposes of meta-analysis. The authors also stated that “the short duration of most studies and the lack of follow-up after treatment cessation leave unanswered whether antidepressants have long-term beneficial effects on FMS symptoms and the optimal treatment duration.” They added, “Since evidence for a long-term effect of antidepressants in FMS is still lacking, their effects should be re-evaluated at regular intervals to determine whether benefits outweigh adverse effects.”
Source
Hauser W, Bernardy K, Uceyler N, Sommer C. Treatment of fibromyalgia syndrome with antidepressants: A meta-analysis. JAMA. 2009;301:198–209.
Coalition promotes important acetaminophen dosing reminders
November 18th 2014It may come as a surprise that each year Americans catch approximately 1 billion colds, and the Centers for Disease Control and Prevention estimates that as many as 20% get the flu. This cold and flu season, 7 in 10 patients will reach for an over-the-counter (OTC) medicine to treat their coughs, stuffy noses, and sniffles. It’s an important time of the year to remind patients to double check their medicine labels so they don’t double up on medicines containing acetaminophen.
Support consumer access to specialty medications through value-based insurance design
June 30th 2014The driving force behind consumer cost-sharing provisions for specialty medications is the acquisition cost and not clinical value. This appears to be true for almost all public and private health plans, says a new report from researchers at the University of Michigan Center for Value-Based Insurance Design (V-BID Center) and the National Pharmaceutical Council (NPC).
Management of antipsychotic medication polypharmacy
June 13th 2013Within our healthcare-driven society, the increase in the identification and diagnosis of mental illnesses has led to a proportional increase in the prescribing of psychotropic medications. The prevalence of mental illnesses and subsequent treatment approaches may employ monotherapy as first-line treatment, but in many cases the use of combination of therapy can occur, leading to polypharmacy.1 Polypharmacy can be defined in several ways but it generally recognized as the use of multiple medications by one patient and the most common definition is the concurrent use of five more medications. The presence of polyharmacy has the potential to contribute to non-compliance, drug-drug interactions, medication errors, adverse events, or poor quality of life.
Medical innovation improves outcomes
June 12th 2013I have been diagnosed with stage 4 cancer of the pancreas, a disease that’s long been considered not just incurable, but almost impossible to treat-a recalcitrant disease that some practitioners feel has given oncology a bad name. I was told my life would be measured in weeks.
