Major Report Says SSRI's Don't Work For Fibromyalgia

Cort

Founder of Health Rising and Phoenix Rising
Staff member
They might help with depression but the Cochrane report concluded that there's no evidence that selective serotonin reuptake inhibitors (SSRI's) do any better than placebo in reducing pain, fatigue or sleep in FM. This doesn't mean they don't help for some people but as a class of drugs they fail to have major effects for most. The major drugs in this class include

Cochrane Database Syst Rev. 2015 Jun 5;6:CD011735. [Epub ahead of print] Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Walitt B1, Urrútia G, Nishishinya MB, Cantrell SE, Häuser W.

Abstract

BACKGROUND:

Fibromyalgia is a clinically well-defined chronic condition with a biopsychosocial aetiology. Fibromyalgia is characterized by chronic widespread musculoskeletal pain, sleep problems, cognitive dysfunction, and fatigue. Patients often report high disability levels and poor quality of life. Since there is no specific treatment that alters the pathogenesis of fibromyalgia, drug therapy focuses on pain reduction and improvement of other aversive symptoms.
OBJECTIVES:

The objective was to assess the benefits and harms of selective serotonin reuptake inhibitors (SSRIs) in the treatment of fibromyalgia.
SEARCH METHODS:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 5), MEDLINE (1966 to June 2014), EMBASE (1946 to June 2014), and the reference lists of reviewed articles.
SELECTION CRITERIA:

We selected all randomized, double-blind trials of SSRIs used for the treatment of fibromyalgia symptoms in adult participants. We considered the following SSRIs in this review: citalopram, fluoxetine, escitalopram, fluvoxamine, paroxetine, and sertraline.
DATA COLLECTION AND ANALYSIS:

Three authors extracted the data of all included studies and assessed the risks of bias of the studies. We resolved discrepancies by discussion.
MAIN RESULTS:

The quality of evidence was very low for each outcome. We downgraded the quality of evidence to very low due to concerns about risk of bias and studies with few participants. We included seven placebo-controlled studies, two with citalopram, three with fluoxetine and two with paroxetine, with a median study duration of eight weeks (4 to 16 weeks) and 383 participants, who were pooled together.All studies had one or more sources of potential major bias. There was a small (10%) difference in patients who reported a 30% pain reduction between SSRIs (56/172 (32.6%)) and placebo (39/171 (22.8%)) risk difference (RD) 0.10, 95% confidence interval (CI) 0.01 to 0.20; number needed to treat for an additional beneficial outcome (NNTB) 10, 95% CI 5 to 100; and in global improvement (proportion of patients who reported to be much or very much improved: 50/168 (29.8%) of patients with SSRIs and 26/162 (16.0%) of patients with placebo) RD 0.14, 95% CI 0.06 to 0.23; NNTB 7, 95% CI 4 to 17.SSRIs did not statistically, or clinically, significantly reduce fatigue: standard mean difference (SMD) -0.26, 95% CI -0.55 to 0.03; 7.0% absolute improvement on a 0 to 10 scale, 95% CI 14.6% relative improvement to 0.8% relative deterioration; nor sleep problems: SMD 0.03, 95 % CI -0.26 to 0.31; 0.8 % absolute deterioration on a 0 to 100 scale, 95% CI 8.3% relative deterioration to 6.9% relative improvement.SSRIs were superior to placebo in the reduction of depression: SMD -0.39, 95% CI -0.65 to -0.14; 7.6% absolute improvement on a 0 to 10 scale, 95% CI 2.7% to 13.8% relative improvement; NNTB 13, 95% CI 7 to 37. The dropout rate due to adverse events was not higher with SSRI use than with placebo use (23/146 (15.8%) of patients with SSRIs and 14/138 (10.1%) of patients with placebo) RD 0.04, 95% CI -0.06 to 0.14. There was no statistically or clinically significant difference in serious adverse events with SSRI use and placebo use (3/84 (3.6%) in patients with SSRIs and 4/84 (4.8%) and patients with placebo) RD -0.01, 95% CI -0.07 to 0.05.
AUTHORS' CONCLUSIONS:

There is no unbiased evidence that SSRIs are superior to placebo in treating the key symptoms of fibromyalgia, namely pain, fatigue and sleep problems. SSRIs might be considered for treating depression in people with fibromyalgia. The black box warning for increased suicidal tendency in young adults aged 18 to 24, with major depressive disorder, who have taken SSRIs, should be considered when appropriate.
 

Paw

Well-Known Member
I may be on a wild goose chase, but I've been pursuing a pet theory that it's the "N" part of my SNRI (Cymbalta) that is relieving my worst FM pain. As I research, and also experiment with supplements that can separately impact serotonin and norepinephrine, I'm interested in possibly transitioning toward something that focuses more exclusively on the "N." Here in the US, Wellbutrin might be the closest drug that fits that description.

I tolerate supplements that encourage dopamine and norepinephrine well, but I have trouble with those that encourage serotonin (they increase fog and fatigue). Since the Cymbalta helps enormously with the pain, but does nothing for the chronic fatigue, I'm wondering if there's a more precise way to target my condition. Will see what my neurologist has to say.

Anyway this study on SSRI's would seem to support my theory, since my SNRI is indisputably helpful.
 

Seeksassy

Active Member
I may be on a wild goose chase, but I've been pursuing a pet theory that it's the "N" part of my SNRI (Cymbalta) that is relieving my worst FM pain. As I research, and also experiment with supplements that can separately impact serotonin and norepinephrine, I'm interested in possibly transitioning toward something that focuses more exclusively on the "N." Here in the US, Wellbutrin might be the closest drug that fits that description.

I tolerate supplements that encourage dopamine and norepinephrine well, but I have trouble with those that encourage serotonin (they increase fog and fatigue). Since the Cymbalta helps enormously with the pain, but does nothing for the chronic fatigue, I'm wondering if there's a more precise way to target my condition. Will see what my neurologist has to say.

Anyway this study on SSRI's would seem to support my theory, since my SNRI is indisputably helpful.
Thanks for this. I like your thinking and think I'll follow up with my doc. I'm experiencing crushing fatigue but serotonin is a problem for me, too.
 

Paw

Well-Known Member
I'm only on my second day of Wellbutrin (and I'm cutting my duloxetine from 90 to 60 at night) -- but the first day's results were encouraging. Sustained energy most of the day. But you know how these things go: consistent improvements over the long haul are rare. Still I'm hopeful.

I suspect I have some kind of acetylcholine receptor damage (maybe caused by an autoimmune disorder); maybe it can be repaired (or at least bolstered) by a better balance of neurotransmitters.

I sometimes find it nice to get to sleep with a little excess dopamine in the system, even I don't conk out as quickly. Lying in bed, gradually falling asleep with some energy still circulating feels more restorative somehow. It has to be the right amount, though, so it doesn't overwhelm.
 

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