Last updated: Apr 28, 2008
patty-hall
An antidepressant helped Patty Hall relieve both her depression and her pain.
(PATTY HALL)
If you're suffering from chronic pain, there's a good chance it may make you depressed and you and your doctor may consider an antidepressant. Or you may be put on an antidepressant to treat pain only. And sometimes these medications are prescribed to treat both conditions at the same time.


The relationship between pain and depression—how one affects the other—isn't always clear. Though both may be treated with one antidepressant drug, they need separate but equal attention. A depressed patient has a reduced chance of successful pain management.

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More about pain medication
"If depression gets the backseat long enough, the patient is doomed to not do well and to lapse from care," says Jan Lewis Brandes, MD, assistant clinical professor of neurology at Vanderbilt University School of Medicine, in Nashville.

Antidepressant drugs tend to work best for pain associated with nerve damage. This includes pain caused by diabetes, shingles, strokes, and sciatica. They may also be taken to treat fibromyalgia and to prevent painful migraines.

The challenge of using a drug with two roles
Because antidepressants play a dual role, they can be tricky to use. Take the case of Patty Hall, 46, of Caledonia, Mich.

Hall was just starting her nursing career when a patient experiencing drug-induced psychosis threw her against the wall, injuring her back and hip. After surgery she developed chronic back and hip pain. For the next six years her pain was manageable and she was able to work as a pediatric nurse.

But then things took a turn for the worse. "I started to fall down and couldn't feel my legs; I was afraid I'd drop the babies," says Hall, who was then 29 years old. Eventually she was diagnosed with fibromyalgia and nerve damage and was forced to give up a career she loved. She soon fell into depression.

At the time, Hall's doctor prescribed Elavil, a tricyclic antidepressant (TCA) for her nerve pain and depression. It went well: "I went from not being able to get the mail, to becoming active again," says Hall.


Then came the weight gain
Hall's pain and depression were relieved by Elavil, but she gained weight (which can be a side effect of the drug when used at a dosage high enough to relieve both pain and depression). The extra weight put pressure on Hall's back and the pain started again. She stopped taking the medication.

A newer class of drugs, serotonin and norepinephrine reuptake inhibitors (SNRIs), may be a better choice for treating both pain and depression because they have fewer side effects at higher doses than do TCAs.

Hall's doctor recommended that she try an SNRI. "On a low dose it worked wonders," says Hall, who took an SNRI called Cymbalta. But over the next four years, she again began to put on extra weight. Her doctor recently recommended that she taper off Cymbalta to try Lyrica, a drug approved in 2007 for the treatment of fibromyalgia, and she gave it a try. Unfortunately her pain worsened. Now she's finding relief back on Cymbalta and plans to stick with it for a while.

The payoff of finding the right drug combination
Antidepressants don't always do the job of treating both pain and depression. You may need other pain meds, says Robert Bonakdar, MD, director of pain management at the Scripps Center for Integrative Medicine in San Diego. He points out how complex the interaction between depression and pain is: Depression can cause pain, just as pain can cause depression.

Careful experimentation with drugs can "tease out how much the pain is compounded by the depression," Dr. Bonakdar says.

Hall finds that staying active and volunteering has helped a great deal. "I decided I could either sit at home and be depressed and have no purpose in life, or I could go out into the world and do things," she says. "I still have issues with pain at times when it's overwhelming, but I've learned to handle it well. It's not as debilitating as it used to be."

"If you can deal better with your pain," says Timothy Moynihan, MD, a medical oncologist at the Mayo Clinic in Rochester, Minn., "you can sleep better, have more energy, and get yourself back to work, or just be a dad and play ball in the yard."

Visit our A-Z Health Library to learn more about how tricyclic antidepressants are used to treat chronic pain and how SNRIs help fibromyalgia.