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.