More and more, we are learning that the same imbalances in neurotransmitters that can cause depression are also involved in chronic neuropathic pain. Moderate relief of neuropathic pain and pain-related sleep problems may be achieved with antidepressants, whether an individual has depression or not. Antidepressants reduce symptoms by fixing imbalances in the nervous system’s neurotransmitters.
The following types of antidepressants are often prescribed for neuropathic pain:
- Tricyclic antidepressants treat diabetic neuropathy, post-herpetic neuralgia (shingles), and central post-stroke pain. These medications include amitriptyline (brand names Amitril, Elavil), imipramine (brand name Tofranil), nortriptyline (brand names Aventyl, Pamelor), and desipramine (brand name Norpramin). The term tricyclic stems from the medication’s chemical structure.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs) duloxetine (brand name Cymbalta) and venlafaxine (brand name Effexor) treat pain related to diabetic neuropathy. Venlafaxine extended-release is also useful in easing the pain of polyneuropathies.
- Combination therapy works well for some people. One such therapy, tapentadol (brand name Nucynta), combines elements of an antidepressant and an opioid. Studies have shown it to have some benefits over the opioid oxycodone.2,3
- Selective Serotonin Reuptake Inhibitors (SSRIs). This group of medications is not typically the first choice by itself, but may be helpful in combination with tricyclic antidepressants or if other medications are not well tolerated. Options include escitalopram (brand name Lexapro), paroxetine (brand names Brisdelle, Paxil, and others), and fluoxetine (brand names Prozac, Sarafem, and others).
Side effects and risks with antidepressants may include, but are not limited to, heart problems, constipation, drowsiness, light-headedness, weight gain, dry mouth, and nausea. Antidepressants also may increase the risk of suicidal thoughts. Women should ask their doctor before taking antidepressants or any other medication during pregnancy.