Reconsidering Antidepressants for Pain

With the ever-changing new on headache and pain, I find myself wanting to edit previous posts. This post is a slightly different take on Antidepressants for Pain, from August.

Using antidepressants for pain isn’t totally random, as they have a track record for doing so — although the strength of that track record is debatable. One explanation for using these meds is that because the disorders commonly appear in the same patients (they are considered comorbid), targeting an area of the brain associated with one may help relieve the other. A few months ago, I would have attributed this to an imbalance in brain chemicals, but now I know better.

In All in My Head, Paula Kamen shows just how vague this carefully contrived explanation is for antidepressants and other preventives:

“…I heard a variety of doctors clearly make an assertion again about the inadequacy of the currently available preventives. ‘Interestingly, a majority of commonly used [preventives] have little evidence of efficacy. In contrast, almost all options have well documented adverse effects, often leading to a discontinuation of preventive therapy,’ read a summary in the program book leading to the presentation of Dr. David W. Dodick, the well-respected director of the Headache Program at the Mayo Clinic branch in Scottsdale, Arizona. This time the assertion was backed up by the citation of many studies, including a major federally sponsored one for 1999 done at Duke University.” (Page 285)

In other words, none of our options are very good. Each person with headache is left to decide if it is better to try all of them and see if any work, try none of them, or somewhere in between. I and most people I talk to take the first approach and have been disappointed time and time again.