Antidepressant treatment of fibromyalgia A meta-analysis and review

Fibromyalgia is a common musculoskeletal pain disorder associated with mood disorders. Antidepressants, particularly tricyclics, are commonly recommen ded treatments. Randomized, controlled trials of antidepressants for treatm ent of fibromyalgia were reviewed by methodology, results, and potential pr edictors of response. Twenty-one controlled trials, 16 involving tricyclic agents, were identified, 9 of these 16 studies were suitable for meta-analy sis. Effect sizes were calculated for measurements of physician and patient overall assessment, pain, stiffness, tenderness, fatigue, and sleep qualit y. Compared with placebo, tricyclic agents were associated with effect size s that were substantially larger than zero for all measurements. The larges t improvement was associated with measures of sleep quality, the most modes t improvement was found in measures of stiffness find tenderness. Further s tudies are needed utilizing randomized, double-blind, placebo-controlled, p arallel designs with antidepressants administered at therapeutic dose range s, using standardized criteria for fibromyalgia and systematically assessed for co-occurring psychiatric illness.