Which combination of antidepressants are effective for the treatment of fibromyalgia?

Updated: Nov 14, 2018
  • Author: Chad S Boomershine, MD, PhD, CPI, CPT; Chief Editor: Herbert S Diamond, MD  more...
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Answer

A useful combination is a TCA (eg, amitriptyline, nortriptyline) in low dosage at bedtime plus a first-generation SSRI (eg, fluoxetine, paroxetine), which allows for improved efficacy with lower dosing that can help prevent adverse effects. [140] However, patients taking combinations of serotonin-active drugs should be closely monitored for the development of serotonin syndrome, [141] and all patients taking antidepressants should be carefully monitored for worsening depression or the emergence of suicidal thoughts.

While many patients find relief with the above-mentioned antidepressants, some fail to tolerate them. For those patients, antidepressants that work via alternative mechanisms are reasonable options. Animal studies have shown that 5-HT1A receptor activation can induce analgesia. [142, 143]


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