Table 2.
Conditions for which antidepressants show evidence of efficacy
| Condition by drug class | Treatment regimen: median (minimum-maximum) dose and duration | Outcome | Effect estimate (95% CI)* | No of trials (No of participants) | Certainty of evidence |
|---|---|---|---|---|---|
| SNRI | |||||
| Back pain32 | Duloxetine 60 (20-120) mg for 13 (13-13) weeks (4 trials) | Pain intensity | MD −5.3 (−7.3 to −3.3) | 4 (1415) | Moderate |
| Postoperative pain16 | Duloxetine 60 (30-60) mg pre-surgery and/or post-surgery for 3 days (1 day to 26 weeks) (15 trials); venlafaxine 37.5 mg for 10 days (1 trial) | Pain intensity (24 hours post-surgery) | MD −7.3 (−12.9 to −1.7) | 16 (1128) | Moderate |
| Fibromyalgia45 | Duloxetine 120 (30-120) mg for 12 (12-27) weeks (7 trials); milnacipran 150 (100-200) mg for 12 (6-27) weeks (8 trials) | Pain reduction ≥50% | RR 1.4 (1.3 to 1.6) | 15 (6918) | Moderate† |
| Neuropathic pain35 | Duloxetine 120 (60-120) mg for 12 (6-12) weeks (8 trials); milnacipran 200 mg for 12 weeks (1 trial); venlafaxine 172.5 (150-225) for 7 (6-8) weeks (2 trials); desvenlafaxine (400 mg for 13 weeks) (1 trial) | Pain intensity | MD −6.8 (−8.7 to −4.8) | 12 (3010) | Moderate† |
| Aromatase inhibitor therapy induced pain in breast cancer52 | Duloxetine 60 mg for 12 weeks (1 trial) | Pain intensity | MD −6.3 (−9.7 to −2.9) | 1 (255) | Low† |
| Depression and comorbid chronic pain31 | Duloxetine 60 (60-60) mg for 9 (8-10 weeks) (9 trials); venlafaxine 177 mg for 12 weeks (1 trial); desvenlafaxine 50 mg for 10 weeks (1 trial) | Pain intensity | MD −6.4 (−7.7 to −5.1) | 11 (3520) | Low† |
| Knee osteoarthritis32 | Duloxetine 60 (60-120) mg for 13 (8-14) weeks (7 trials); milnacipran 200 mg for 8 weeks (1 trial) | Pain intensity | MD −9.6 (−12.3 to −6.9) | 8 (1941) | Low† |
| SSRI | |||||
| Depression and comorbid chronic pain31 | Paroxetine 20 (20-20) mg for 8 weeks (2 trials); fluoxetine 20 mg for 7 weeks (1 trial); escitalopram 10 mg for 12 weeks (1 trial) | Pain intensity | MD −5.9 (−10.1 to −1.7) | 4 (947) | Low† |
| TCA | |||||
| Irritable bowel syndrome56 | Amitriptyline 10 mg for 8 weeks (1 trial); nortriptyline 10 mg for 8 weeks (1 trial); doxepin 75 mg for 6 weeks (1 trial); desipramine 150 mg for 8 weeks (1 trial) | Abdominal pain not improving | RR 0.6 (0.4 to 0.8) | 4 (184) | Low† |
| Neuropathic pain17 | Amitriptyline 75 (65-150) for 5 (4-8) weeks (9 trials); desipramine 201 (160-250) for 6 (6-8) weeks; (3 trials); imipramine 150 mg for 4 weeks (1 trial); maprotiline 75 mg for 4 weeks (1 trial); nortriptyline 100 mg for 9 weeks (1 trial) | Pain reduction ≥30% | RR 3.4 (2.1 to 5.5) | 14 (948) | Low |
| Chronic tension-type headache51 | Amitriptyline 100 (50-150) mg for 12 (8-26) weeks | Headache frequency (days) | MD −4.8 (−6.6 to −3) | 4 (197) | Low† |
CI=confidence interval: MD=mean difference; RR=risk ratio; SNRI=serotonin-norepinephrine reuptake inhibitors; SSRI=selective serotonin reuptake inhibitors; TCA=tricyclic antidepressants.
*
Pain intensity outcomes are on a 0-100 scale unless stated otherwise.
†
Grading of recommendations assessment, development, and evaluation determined by current authors (see supplementary file 5 for details of the assessment).