Table 3.
Conditions for which antidepressants are not efficacious, by class and certainty of evidence
| 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 |
|---|---|---|---|---|---|
| SSRI | |||||
| Back pain32 | Paroxetine 25 (20-30) mg for 8 weeks (2 trials); fluoxetine 16-514 ng/mL for 12 weeks (1 trial) | Pain intensity | MD 1.5 (−5.4 to 8.5) | 3 (170) | Low |
| Fibromyalgia47 | Fluoxetine 62.5 (20-80) mg for 12 (6-12) weeks (3 trials); citalopram 40 mg for 12 (8-16) weeks (2 trials); paroxetine 20 mg for 8 weeks (1 trial) | Pain reduction ≥30% | RR 1.4 (1 to 2) | 6 (343) | Low |
| Functional dyspepsia36 | Venlafaxine 150 mg for 8 weeks (1 trial); sertraline 50 mg for 8 weeks (1 trial) | Pain intensity | MD 1.3 (−5.9 to 8.5) | 2 (291) | Low† |
| Non-cardiac chest pain62 | Paroxetine 45 (40-50) mg for 10 (8-12) (2 trials); sertraline 200 for 9 (8-10) weeks mg (2 trials) | Pain intensity | MD −3.8 (−9.8 to 2.3) | 4 (184) | Low† |
| TCA | |||||
| Functional dyspepsia36 | Amitriptyline 37.5 (25-50) mg for 10 (8-12) weeks (2 trials); imipramine 50 mg for 12 weeks (1 trial) | Pain intensity | MD −2.3 (−7.3 to 2.8) | 3 (293) | Moderate† |
CI=confidence interval; MD=mean difference; RR=risk ratio; 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).