Fibromyalgia; Treatment

NWHRC Health Center - Fibromyalgia, June 8, 2005

Working on a positive attitude and improving your coping skills can also help. Improved sleep can decrease fatigue and pain.

Depression often accompanies fibromyalgia, although it is unclear whether the depression helps cause the disease, is a symptom of the disease, or arises in response to pain and other symptoms. Estimates vary, but 18 percent to 36 percent of fibromyalgia patients are depressed at any given time, and they have a greater than 50 percent risk of experiencing depression in their lifetime. However, despite the association, not everyone with fibromyalgia is depressed or will experience depression. If you have fibromyalgia and are also depressed, treating depression can help free your energy to manage the disease. But even if you don't have depression, antidepressants may be prescribed, since they have proven effective at treating some patients' symptoms in clinical trials.

Antidepressants, particularly nortriptyline (Pamelor), trazodone (Desyrel), doxepin (Sinequan) and amitriptyline (Elavil or Endep), are effective for pain and sleeplessness in some cases. In clinical trials, a combination of fluoxetine (Prozac) and amitriptyline worked better than the either drug alone. The drugs may work by addressing neurochemical imbalances, such as low levels of serotonin (a chemical in the brain that affects mood). Prozac is a selective serotonin reuptake inhibitor (SSRI) and can help keep normal levels of serotonin in the bloodstream. Tricyclic antidepressants can help patients relax and sleep better, but have side effects such as grogginess and dry mouth.

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