Antidepressants for Nerve Pain

One treatment option for neuropathy is using antidepressants for nerve pain relief.

Neuropathic Pain

A chronic condition, neuropathic pain is typically “accompanied by tissue injury”. The nerve fibers might be injured or damaged in some way, which leads them to send the wrong signals. Phantom limb syndrome is one such neuropathic pain. There are many causes of nerve pain, besides amputation, including chemotherapy, diabetes, alcoholism, hip, leg, and back problems, HIV/AIDS, facial nerve issues, multiple sclerosis, spine surgery, and shingles. The neuropathic pain could be felt as tingling and numbness or burning and shooting pain. Some treatment options for neuropathic pain include physical therapy, relaxation therapy, massage, acupuncture, and counseling. There are some nerve pain medication treatments, such as NSAIDs or stronger pain killers, but some patients may benefit from antidepressant and anticonvulsant medications.¹Other patients may use local anesthetics, such as lidocaine.²

Antidepressants for Nerve Pain Patients

Even if a patient is not depressed, tricyclic antidepressants may benefit them and relieve their nerve pain. Tricyclics are a treatment for neuropathy, and they seem to help patients with diabetic neuropathy, arthritis, post herpetic neuralgia (shingles), stroke, radiculopathy, peripheral neuropathy, spinal cord injury, migraine, facial pain, fibromyalgia, and lower back and pelvic pain. A tricyclic antidepressant seems to work by increasing the spinal cord neurotransmitters so that they reduce the pain signals. The maximum pain relief could take weeks. Some patients may take amitriptyline for pain, while others might prefer imipramine, clomipramine, doxepin, nortriptyline, or desipramine. Antidepressant side effects include dry mouth, blurred vision, drowsiness, lightheadedness, constipation, trouble thinking, weight gain, difficulties with urination, and heart rhythm issues. Aside from the trycyclics (TCAs), there are antidepressants with fewer side effects such as serotonin and norepinephrine reuptake inhibitors (SNRIs) or selective serotonin reuptake inhibitors (SSRIs), such as Effexor, Cymbalta, and Savella, or Paxil, Sarafem, and Prozac. SSRIs are not as effective for pain, though. One issue with antidepressant medications is that they may increase suicidal thoughts.³ Recent research has found that the more effective antidepressants for pain are tricyclics, but the bothersome side-effects could be an issue. The FDA has recently approved duloxetine for neuropathic pain. It inhibits norepinephrine and serotonin. Its side-effects include fatigue, dizziness, nausea, and somnolence. Brupropion inhibits dopamine and norepinephrine, and it is considered effective, but it is contraindicated in patients with a history of eating disorders or seizures. Venlafaxine, a “mixed-action antidepressant”, has milder side effects than TCAs, but it could elevate blood pressure.⁴