SSRI's (Celex, Prozac, Paxil) Not Effective in Fibromyalgia


Founder of Health Rising and Phoenix Rising
Staff member
This large overview suggests SSRI's such as Celexa, Prosac, Lexapro and others are not particularly effective for fibromyalgia.

SSRI's are antidepressant drugs that increase the availability of serotonin to the brain. Some evidence suggests that serotonin levels may be low in fibromyalgia and chronic fatigue syndrome.

[/fright]The large review looked for all placebo-controlled, double-blinded studies involving Celexa (citalopram), Prozac (fluoxetine), Lexapro (escitalopram), fluvoxamine, Paxil (paroxetine), and sertraline. In general the reviewers found that the quality of the studies was low.

The SSRI's did result in some increase in "global improvement" but not in pain, sleep or fatigue relative to placebo. They were, however, significantly better at relieving depression - if depression was present. As with all overviews idiosyncratic individual responses are lost; i.e. some people, just not many, may do very well on the drugs.

It should also be noted that significant improvements were found in pain etc. in about 30% of the patients. They just weren't statistically superior to the improvements reported by those on the placebo. The number needed to treat to get a good response (a 30% reduction in pain) was 10 patients. Neither fatigue nor sleep were helped by the drugs.

Dr. Murphree believes that if serotonin is not being produced in sufficient quantities then SSRI's will probably be little help since they simply increase the availability of an already low substance. He reports that 5-HTP - which increases serotonin levels (instead of increasing serotonin availability) - can be quite helpful in fibromyalgia.

Sao Paulo Med J. 2015 Oct;133(5):454. doi: 10.1590/1516-3180.20151335T1. Selective serotonin reuptake inhibitors for fibromyalgia syndrome.
Walitt B, Urrútia G, Nishishinya MB, Cantrell SE, Häuser W.


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.

To assess the benefits and harms of selective serotonin reuptake inhibitors (SSRIs) in the treatment of fibromyalgia.

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.

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.

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.

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