How Do Antidepressants Help Pain?

Antidepressants for Pain
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Pain and depression may be related to each other in a couple of ways.  First of all, dealing with pain and the physical disability that may accompany it can be very stressful; and, when a person's stress level exceeds their ability to cope, this may trigger depression.  Secondly, depression itself can sometimes cause pain as a symptom.  While it is unclear exactly why this happens, it is probably related to the dysregulation of the neurotransmitters serotonin and norepinephrine, which are thought to play a role in both mood disorders and pain.

Antidepressants, especially those which inhibit the reuptake of these two neurotransmitters, can be helpful in treating coexisting pain and depression.  The most common antidepressants used to treat pain are the tricyclic antidepressants, such as amitriptyline, doxepin and imipramine.  Other antidepressants which may help with pain include serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine and duloxetine.  Selective serotonin reuptake inhibitors (SSRIs) have not been shown to be consistently effective against pain.

The types of pain which antidepressant work best with include the following:

  • Arthritis pain
  • Diabetic nerve pain
  • Pain following an episode of shingles
  • Other types of nerve pain
  • Tension headache
  • Migraine
  • Facial pain
  • Fibromyalgia
  • Lower back pain
  • Pelvic pain

Antidepressants do not immediately relieve pain.  It may take a around a week for people to begin to experience pain relief and it may take even longer for the medication to exert its full effect.

  Generally people will experience moderate pain relief from using an antidepressant.  Other medications with different mechanisms of action may be added to give further pain relief.

People using tricyclic antidepressants for depression and pain should be aware that these medications tend to cause certain side effects, including:

  • Blurred vision
  • Constipation
  • Difficulty urinating
  • Dizziness on standing
  • Dry mouth
  • Heart rhythm problems
  • Problems with thinking clearly
  • Sleepiness
  • Weight gain

SNRIs and SSRIs are better tolerated, but may not be as effective for pain relief.  A person's need for pain relief will be have to be weighed against his ability to tolerate these side effects when choosing which antidepressant to use.

In order to minimize side effects, many doctor will start their patients at a lower dose and gradually work up to a higher dose.  The good news, however, is that lower doses tend produce less severe side effects while still being effective for pain management.


"Antidepressants:  Another Weapon Against Chronic Pain."  Mayo Clinic.  Mayo Foundation for Medical Education and Research.  Published:  April 22, 2013.  Accessed:  Novemeber 24, 2015.

Moultry, Aisha Morris.  "The Use of Antidepressants for Chronic Pain."  U.S. Pharmacist.  34.5 (2009):  26-34.

"Pain Management:  Chronic Pain and Depression."  WebMD.  WebMD, LLC.  Reviewed:  By Joseph Goldberg, MD on April 19, 2015.  Accessed:  Novemeber 24, 2015.

Sansone, Randy A. and Lori A. Sansone.  "Pain, Pain, Go Away."  Psychiatry.  5.12 (December 2008):  16-19. 

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