Antidepressants for chronic pain

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Antidepressants For Chronic Pain Anwer
Ghani FRIBM Iraq
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Antidepressants (ADs) Classes A-Non-Norepinephrin
ic 1- Melatonergic (MRAs) 2- Serotonin-antagonist-
and-reuptake-inhibitor (SARI) 3-Selective
serotonin reuptake inhibitors (SSRIs) 4- 5-HT 2
receptors antagonist (HT2RAs)
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Antidepressants (ADs) Classes B-
Norepinephrinic 1- Noradrenergic and specific
serotonergic antidepressant (NSSAs) 2-
Norepinephrine reuptake inhibitor (NRIs) 3-
Selective serotonin and norepinephrine reuptake
inhibitor (SSNRI) 4- Norepinephrine-dopamine
reuptake inhibitors (NDRIs) 5- Tricyclic
antidepressant (TCAs) (serotonin-norepinephrine
reuptake inhibitors (SNRIs) (non-selective). 5-Mon
oamine oxidase inhibitor (MAOIs) serotonin,
norepinephrine, and dopamine breakdown inhibitor
(SNDBI). 7-Selective monoamine oxidase-B
inhibitor (SMAOBIs) serotonin- norepinephrine
breakdown inhibitor (SNDBI).
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ADs are effective (well-studied) in the following
Pain conditions Diabetic neuropathy IBS Migrain
e Chronic pain Fibromyalgia
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The safety The safety is more important. The
safest groups on BP, CV, GIT, SF are (MRAs)gt
(SARI) gt (SSRIs). Others are less safe or
unsafe. All of these drugs are effective in
treating chronic pain.
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Selection 1st line Melatonergic (MRAs) ex
Agomelatine. 2nd line Serotonin-antagonist-and-re
uptake-inhibitor (SARI) ex Trazodone. 3rd line
Selective serotonin reuptake inhibitors (SSRIs)
ex Sertraline. -Other types better to be
avoided. -This selection can also be made in
classic uses such as depression and anxiety.
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Notes 1- MRAs and SARIs do not cause weight
gain. 2- IBS-C use SSRI 3- IBS-D SARI 4-
Milnacipran is an SNRI analgesic. 5- Linezolid
is a MAOI antibiotic. 6- ADs are not addictive.
However, stopping antidepressant treatment
abruptly or missing several doses may cause
withdrawal-like symptoms.
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Thanks