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A Meta-analysis

Winfried Häuser, MD; Kathrin Bernardy, PhD; Nurcan Üçeyler, MD; Claudia Sommer, MD

JAMA. 2009;301(2):198-209.

Context  Fibromyalgia syndrome (FMS) is a chronic pain disorder associated with multiple debilitating symptoms and high disease-related costs. Effective treatment options are needed.

Objectives  To determine the efficacy of antidepressants in the treatment of FMS by performing a meta-analysis of randomized controlled clinical trials.

Data Sources  MEDLINE, PsycINFO, Scopus, and the Cochrane Library databases were searched through August 2008. Reference sections of original studies, meta-analyses, and reviews on antidepressants in FMS were reviewed.

Study Selection  Randomized placebo-controlled trials with tricyclic and tetracyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and monoamine oxidase inhibitors (MAOIs) were analyzed.

Data Extraction and Data Synthesis  Two authors independently extracted data. Effects were summarized using standardized mean differences (SMDs) by a random-effects model.

Results  Eighteen randomized controlled trials (median duration, 8 weeks; range, 4-28 weeks) involving 1427 participants were included. Overall, there was strong evidence for an association of antidepressants with reduction in pain (SMD, –0.43; 95% confidence interval [CI], –0.55 to –0.30), fatigue (SMD, –0.13; 95% CI, –0.26 to –0.01), depressed mood (SMD, –0.26; 95% CI, –0.39 to –0.12), and sleep disturbances (SMD, –0.32; 95% CI, –0.46 to –0.18). There was strong evidence for an association of antidepressants with improved health-related quality of life (SMD, –0.31; 95% CI, –0.42 to –0.20). Effect sizes for pain reduction were large for TCAs (SMD, –1.64; 95% CI, –2.57 to –0.71), medium for MAOIs (SMD, –0.54; 95% CI, –1.02 to –0.07), and small for SSRIs (SMD, –0.39; 95% CI, –0.77 to –0.01) and SNRIs (SMD, –0.36; 95% CI, –0.46 to –0.25).

Conclusion  Antidepressant medications are associated with improvements in pain, depression, fatigue, sleep disturbances, and health-related quality of life in patients with FMS.

Author Affiliations: Department of Internal Medicine, Klinikum Saarbrücken, Saarbrücken, Germany (Dr Häuser); Department of Anesthesiology, Emergency Medicine and Pain Therapy, University of Saarland, Saarbrücken (Dr Bernardy); Department of Psychosomatic Medicine, MediClin Bliestal Clinics, Blieskastel, Germany (Dr Bernardy); and Department of Neurology, University of Würzburg, Würzburg, Germany (Drs Üçeyler and Sommer).

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