Psychosomatics 41:104-113, April 2000
© 2000 The Academy of Psychosomatic Medicine
Antidepressant Treatment of Fibromyalgia
A Meta-Analysis and Review
Lesley M. Arnold, M.D.,
Paul E. Keck, Jr., M.D., and
Jeffrey A. Welge, Ph.D.
Received March 2, 1999; revised July 20, 1999; accepted July 28, 1999. From the Biological Psychiatry Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio; and the Center for Biostatistical Services, University of Cincinnati Medical Center, Cincinnati, Ohio. Address reprint requests to Dr. Arnold, Department of Psychiatry, University of Cincinnati College of Medicine, P.O. Box 670559, 231 Bethesda Avenue, Cincinnati, OH 45267–0559; e-mail: arnoldlm{at}email.uc.edu
Fibromyalgia is a common musculoskeletal pain disorder associated with mood disorders. Antidepressants, particularly tricyclics, are commonly recommended treatments. Randomized, controlled trials of antidepressants for treatment of fibromyalgia were reviewed by methodology, results, and potential predictors of response. Twenty-one controlled trials, 16 involving tricyclic agents, were identified; 9 of these 16 studies were suitable for meta-analysis. Effect sizes were calculated for measurements of physician and patient overall assessment, pain, stiffness, tenderness, fatigue, and sleep quality. Compared with placebo, tricyclic agents were associated with effect sizes that were substantially larger than zero for all measurements. The largest improvement was associated with measures of sleep quality; the most modest improvement was found in measures of stiffness and tenderness. Further studies are needed utilizing randomized, double-blind, placebo-controlled, parallel designs with antidepressants administered at therapeutic dose ranges, using standardized criteria for fibromyalgia and systematically assessed for co-occurring psychiatric illness.
Key Words: Antidepressants • Fibromyalgia
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