Serotonin and norepinephrine reuptake inhibitors (SNRIs) for fibromyalgia

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Serotonin and norepinephrine reuptake inhibitors (SNRIs) for fibromyalgia

Examples

Generic NameBrand Name
duloxetineCymbalta
venlafaxineEffexor

How It Works

SNRIs work to increase the activity of brain chemicals called serotonin and norepinephrine. Doctors do not know exactly how this improves fibromyalgia symptoms.

Why It Is Used

Doctors may prescribe serotonin and norepinephrine reuptake inhibitors (SNRIs) when mood problems are a major symptom of fibromyalgia. SNRIs are also used for people without fibromyalgia who have depression.

How Well It Works

Some people with fibromyalgia who take SNRIs notice an improvement in a number of symptoms, including depression, pain, and fatigue.2

Side Effects

Side effects of SNRIs can include:

  • Cough and sore throat.
  • Nausea and loss of appetite.
  • Problems with bowel movements.
  • Sleep problems.
  • Loss of sexual desire or ability.
  • Weight loss.
  • Dilated pupils.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued advisories on antidepressant medicines and the risk of suicide. It is not recommended that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

Health Canada and the FDA have also issued warnings about taking triptans, used for headaches, with SSRIs (selective serotonin reuptake inhibitors) or SNRIs (selective serotonin/norepinephrine reuptake inhibitors). Taking these medicines together can cause a very rare but serious condition called serotonin syndrome.

What To Think About

Treatment with antidepressants does not always relieve symptoms caused by fibromyalgia. Even when the treatment does work, some people may find the side effects of these medicines unacceptable.

Using an antidepressant medicine to treat fibromyalgia does not mean that the condition is "all in your head."

Venlafaxine makes bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking venlafaxine with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.1

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

Citations

  1. Abajo FJ, Garcia-Rodriguez LA (2008). Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy. Archives of General Psychiatry. 65(7): 795–803.
  2. Goldenberg DL, et al. (2004). Management of fibromyalgia syndrome. JAMA, 292(19): 2388–2395.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Richa Dhawan, MD - Rheumatology
Specialist Medical Reviewer Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
Last Revised January 26, 2010

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.