Finding relief from spine-related back and neck pain often is not a simple or quick fix. Besides pain, other symptoms may be widespread and affect your whole life. You may feel fatigued or develop sleep disturbances. Your pain may spread from the physical to the mental and emotional. Anxiety, irritability, and depression are common if you have chronic pain, and this can certainly diminish your overall sense of well-being. That's why your doctor may recommend and prescribe an antidepressant medication as part of your multidisciplinary treatment plan.
Doctors prescribe antidepressants to their back pain patients for a number of reasons—to help reduce pain and muscle tension, regain healthy sleep patterns, and of course, address the mental and emotional toll of pain. In most cases, doctors prescribe antidepressants in lower doses to treat back pain than would be prescribed to treat depression alone.
While the pain-relieving ability of an antidepressant isn’t fully understood, it’s believed that these drugs work in the central nervous system (which includes your brain and spinal cord) to reduce pain signals. This is why antidepressants are particularly well-suited for people with neuropathic pain—that is pain that originates from the nerves. Fibromyalgia is an example of a neuropathic pain condition.
There are many types of antidepressants. This article describes 4 classes of antidepressants commonly prescribed for chronic back pain.
Here's how TCAs work: When certain chemicals in your brain become imbalanced, you may experience pain and have difficulty sleeping. TCAs help regain balance by raising the levels of calming neurotransmitters—namely serotonin, norepinephrine, and dopamine—in your brain.
Examples of TCAs are listed below (the generic names are listed first, with a brand name example in parentheses):
Side effects of TCAs include nausea, weight changes, drowsiness, dizziness, dry eyes and mouth, and constipation. If you experience more serious side effects—such as increased heart rate, sudden numbness or headache, or blurred vision—seek medical help immediately.
This class of antidepressants increases serotonin and norepinephrine by stopping their reuptake (reabsorption) into brain cells. Increased levels of these chemicals help maintain mental balance and reduce the amount of pain you feel. Duloxetine (Cymbalta) and milnacipran (Savella) are SNRIs that doctors commonly prescribe for chronic pain, particularly when it's associated with fibromyalgia.
Another example of an SNRI is venlafaxine (Effexor), though it is less often prescribed for back pain.
Side effects of SNRIs include dizziness, insomnia, and drowsiness. To combat the sleep problems associated with SNRIs, your doctor may also prescribe a tricyclic antidepressant (TCA) to curb any sleep disruptions. If you experience serious side effects, including extreme nausea or blurred vision, seek medical help immediately.
SSRIs boost your mood by allowing more serotonin to travel from neuron to neuron in your brain. More serotonin means less pain perception. SSRIs are very similar to SNRIs—the main difference being that SNRIs affect with serotonin and norepinephrine.
Examples of SSRIs are:
SSRIs are particularly effective at reducing fatigue, but they are not flawless medications. They aren’t as effective as TCAs at reducing pain, and there’s little evidence connecting SSRI to reduced nerve pain. Like SNRIs, they may interfere with sleep, so your doctor may also prescribe a TCA to prevent sleep disturbances. Other side effects include nausea, dry mouth, weight gain, and drowsiness. If you experience serious side effects, such as increased heart rate or seizures, seek medical help immediately.
NDRIs are known as atypical because these drugs are chemically unrelated to other types of antidepressants, although they work in similar ways. Bupropion (brand, Wellbutrin) is one of these medications. Like other antidepressants, there is potential for side effects. However, unlike other types of antidepressant drugs, bupropion does not cause weight gain (in some patients, a contributing factor to low back pain).
While more research needs to be conducted to better understand how antidepressants reduce back pain, they are a widely accepted part of a multidisciplinary treatment approach. As always, clear communication with your doctor is essential. Don't be afraid to speak up with any questions or concerns you have about your medications.