Chronic low back pain is known to cause depression, and depression makes it more difficult to deal with pain. Therefore, it is often important for low back pain and depression to be treated simultaneously for the treatment to be successful.
The first generation of antidepressant or antidepressant medication (e.g. tricyclics, monoamine oxidase inhibitors) had significant side effects and are no longer used to treat depression. However, the tricyclics (Amytriptiline, Nortriptiline, and Imipramine) are prescribed in lower doses as sedatives to help patients with difficulty sleeping. These old antidepressants or sleep-aids are not addictive and do not change a patient’s sleep cycles, and therefore may be taken on a long-term basis. Initially, most patients feel groggy the morning after taking a tricyclic, but this “hangover”” effect typically goes away quickly. Tricyclic medications also seem to diminish pain if taken on a regular basis, although the mechanism for this pain relieving effect is not known.
A new class of antidepressant is now used to treat depression: selective serotonin reuptake inhibitors (SSRI’s). Serotonin is a neurotransmitter in the brain that affects mood. Examples of SSRIs include Prozac, Paxil, Zoloft, and Wellbutrin. Cymbalta is another newer medications that has dual functions to reduce symptoms of depression and anxiety but also chronic neuropathic pain.
Some of these antidepressant and other medications have relatively few side effects. However, it is important to note that they have a potentially fatal drug interaction with monoamine oxidase inhibitors (e. g. Nardil, Parnate, Marplan) and should not be taken together.
Antidepressants as sleep aids
Depression is a common occurrence in a chronic pain condition, and insomnia is quite common in depression. If the individual with chronic pain is also experiencing clinical depression, treating the depression with psychological treatment and an appropriate antidepressants (antidepressant medication), if indicated, may also help with the sleep disruption as well as other symptoms of depression.
Even in chronic back pain patients who are not experiencing significant or clinical depression, sedating antidepressants are often used in low doses to help with insomnia as well as providing some analgesic (pain relieving) benefit. The sedating antidepressants most commonly used to help with sleep include Trazodone(Desyrel), Amitriptyline (Elavil), and Doxepin (Sinequan). It should be noted that when these medications are used for sleeping and pain relieving properties, it is in much lower doses than when used in the treatment of depression.
Benefits of these antidepressants include:
- they are non-addictive
- added benefit of providing some analgesic benefit as compared to the hypnotic class of medications discussed previously (which have no pain relieving properties)
- do not produce physical dependence or tolerance
- generally have a low incidence of side effects, especially when used in low doses.
Some individuals do experience adverse side effects, including such things as dry mouth, blurred vision, a “hangover” in the morning, constipation, urinary retention, and nausea.
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