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Selective Serotonin Reuptake Inhibitors (SSRIs) for Fibromyalgia

Examples

Generic Name Brand Name
citalopram Celexa
escitalopram Lexapro
fluoxetine Prozac
paroxetine Paxil
sertraline Zoloft

How It Works

Experts do not know exactly how SSRIs work to improve fibromyalgia. But some people with fibromyalgia who take SSRIs seem to have improved mood and less fatigue.

These medicines are a type of antidepressant. Doctors also prescribe them to treat depression.

Why It Is Used

Doctors may prescribe SSRIs when mood problems are a major symptom of fibromyalgia.

How Well It Works

SSRIs seem to improve mood and may help relieve pain, fatigue and sleep problems.1 Some people taking fluoxetine report decreased pain and improved ability to function.2

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.
  • Thoughts of suicide.
  • Agitation and restlessness.
  • Seizures.
  • Fast heartbeat.
  • Nausea and vomiting.

Common side effects of this medicine include:

  • Loss of sexual desire or ability.
  • Irritability.
  • Trouble sleeping or drowsiness.
  • Headache.
  • Changes in appetite.

FDA advisories. The U.S. Food and Drug Administration (FDA) has issued:

  • An advisory on antidepressant medicines and the risk of suicide in children and adults. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
  • A warning about taking triptans, used for headaches, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Never suddenly stop taking antidepressants. The use of any antidepressant should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medicine can cause negative side effects or a relapse into a depressive episode.

People with liver disease usually require lower doses of SSRIs.

Studies have found that daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Talk to your doctor about this risk before taking an SSRI.3

SSRIs make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.4

Sexual dysfunction can be a significant problem for some people while taking an SSRI. A medicine such as sildenafil (Viagra) may help both men and women who have sexual problems caused by SSRIs.5, 6

Studies suggest that using a selective serotonin reuptake inhibitor (SSRI) and a tricyclic antidepressant (such as amitriptyline) together may be more successful at breaking the cycle of pain and sleep problems caused by fibromyalgia than using just a single medicine.

Treatment with antidepressants does not always relieve symptoms caused by fibromyalgia. Even when the treatment does work, some people may find the side effects of these medicines unacceptable. The dose of an SSRI used to treat fibromyalgia is usually the same as that needed to treat depression.

Using an antidepressant medicine to treat fibromyalgia does not mean that the condition is "all in your head."

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Women who take an SSRI during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant, you and your doctor must weigh the risks of taking an SSRI against the risks of not treating your panic disorder.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Rao SR, Clauw DJ (2004). The management of fibromyalgia. Drugs of Today, 40(6): 539–554.
  2. Bradley LA, Alarcon GS (2005). Fibromyalgia section of Miscellaneous rheumatic diseases. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 1869–1910. Philadelphia: Lippincott Williams and Wilkins.
  3. Richards JB, et al. (2007). Effect of selective serotonin reuptake inhibitors on the risk of fracture. Archives of Internal Medicine, 167(2): 188–194.
  4. Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy. Archives of General Psychiatry, 65(7): 795–803.
  5. Nurnberg HG, et al. (2003). Treatment of antidepressant-associated sexual dysfunction with sildenafil. JAMA, 289(1): 56–64.
  6. Nurnberg GH, et al. (2008). Sildenafil treatment of women with antidepressant-associated sexual dysfunction: A randomized controlled trial. JAMA, 300(4): 395–404.

Credits

By Healthwise Staff
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Karin M. Lindholm, DO - Neurology
Last Revised May 14, 2012

Last Revised: May 14, 2012

Author: Healthwise Staff

Medical Review: Anne C. Poinier, MD - Internal Medicine & Karin M. Lindholm, DO - Neurology

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