Antidepressants are used to fight the depression that can come with chronic pain, but they also act directly on pain in some patients, and are used in the treatment of fibromyalgia and other chronic pain conditions.

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Michele Combs, 37, a nursery-school director from Newburgh, Ind., began taking a tricyclic antidepressant for depression during her senior year of high school. “Once I got through the temporary side effects of tiredness and night sweats, life got pretty good again,” says Combs, who had also experienced muscle aches and difficulty sleeping.

At 25, just when things were looking a lot brighter for Combs, and as she was considering going off the medication, she started to suffer from extreme muscle pain and was eventually diagnosed with fibromyalgia. Her doctors recommended that she stay on the antidepressant to help treat the pain. During the course of two pregnancies, Combs stopped the medication and felt some relief, thanks to pregnancy hormones. However, she returned to antidepressants after each birth.

Although she was first prescribed tricyclics, a newer class of antidepressants—serotonin-norepinephrine reuptake inhibitors (SNRIs)—later came on the market and are used to treat both pain and depression with fewer side effects. SNRIs act on two brain chemicals, serotonin and norepinephrine, but it is not yet known exactly how that helps relieve pain.

Combs is currently taking two different SNRIs. “One helps me sleep, which is so important for fibromyalgia, and the combination makes me feel better than I have in a long time,” says Combs.

In fact, the combination has yielded remarkable benefits.

“In my wildest dreams, I never thought I could be active and flexible enough to take care of babies," she says. "Ive come a really long way. I know a lot has to do with the drugs. Theyre what got me out of my depression and got me going again.”