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Antidepressants for Chronic Pain: Are We Overmedicating?

Antidepressants have long been used to treat chronic pain, but recent studies suggest that their effectiveness is questionable. While these medications have benefits for depression and anxiety, their use in chronic pain management has been widely debated. On this page, we explore the use of antidepressants for chronic pain, their effectiveness, and potential side effects.

The Use of Antidepressants for Chronic Pain

Antidepressants work by altering the levels of neurotransmitters in the brain, such as serotonin and norepinephrine, which can help to alleviate depression and anxiety. These medicines have also been promoted as having a pain-relieving effect and are often prescribed for chronic pain conditions such as fibromyalgia and neuropathic pain. However, recent research suggests that their effectiveness for chronic pain may be limited.

Despite this, antidepressants are commonly prescribed as a first line treatment for chronic pain, most often off-label. 

Worse, many GPs are force tapering their patients off their opioid pain-relieving medications, which the evidence shows ARE safe and effective.  And instead offering antidepressants as an alternative.

I have received many messages from people who are being force tapered off their opioids and offered antidepressants as an alternative medication to manage their pain.

Some have been bullied into taking antidepressants and even blackmailed (“If you do not try this antidepressant I can no longer prescribe your opioid pain medications due to non-compliance”)

This page is a collection of research on antidepressants of all classes as treatment for chronic pain; their safety, their efficacy and which chronic pain conditions they are or are not effective for.

The Evidence

February 2023

Antidepressants are ineffective as a treatment for chronic pain

This very large study review of 22 studies between 2010 and 2020 of over 25,000 patietns found that antidepressants are most often prescribed off label and are not effective for most chronic pain conditions.

Despite this, prescribing levels are increasing, and more judicious prescribing is recommended.