SSRI medications in treatment of fibromyalgia
Level of evidence: C
SSRI medications may decrease fibromyalgia symptoms and fibromyalgia-related pain slightly.
A Cochrane review on SSRI medications to treat fibromyalgia symptoms «Walitt B, Urrútia G, Nishishinya MB, et al. Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database Syst Rev 2015;2015(6):CD011735 »1 found a small impact on the total symptoms and fibromyalgia-related pain. The average pain decreased by about 14 % in comparison to the control. The impact was similar on the fibromyalgia-related quality of life (i.e. total symptoms). SSRI medications may also decrease depression symptoms (standardized mean difference -0.39, 95 % CI -0,65 to -0,14).
Specific adverse events were not evaluated. However, for treatment of anxiety, SSRI medications increased the risk of nausea (risk difference 11 %), muscle weakness (11 %), somnolence (9 %), dry mouth (7 %), sweating (8 %), loss of libido (7 %), and ejaculation dysfunction (12 %) «Gosmann NP, Costa MA, Jaeger MB, et al. Incidence of adverse events and comparative tolerability of selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for th»2.
We downgraded the level of evidence due to study limitations (high dropout rates) and imprecision.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis; FIQ = fibromyalgia impact questionnaire | |||||
| «Walitt B, Urrútia G, Nishishinya MB, et al. Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database Syst Rev 2015;2015(6):CD011735 »1 | SR/MA | Adults with fibromyalgia | SSRI vs placebo | Mean pain intensity, FIQ | High |
| Reference | Comments |
|---|---|
| «Walitt B, Urrútia G, Nishishinya MB, et al. Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database Syst Rev 2015;2015(6):CD011735 »1 | High dropout rates. Randomization and blinding ok. |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean change from baseline (sd) I | Mean at follow up C | Mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: low The quality of evidence is downgraded due to study limitations and imprecision. I=intervention; C=comparison; CI=confidence interval *Calculated by reanalysing the provided data. Random-effects meta-analysis. | |||||
| «Walitt B, Urrútia G, Nishishinya MB, et al. Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database Syst Rev 2015;2015(6):CD011735 »1 | 7 studies (163/167) | 6-16 weeks | - | 6,21 | SMD – 0,37 (-0,69 to -0,04) MD of -0,89 (-1,66 to -0,1)* Relative decrease -14% (-27 % to -2 %) |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean change from baseline (sd) I | Mean at follow up C | Mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: very low The quality of evidence is downgraded due to study limitations (large dropout rate and one crossover trial with short washout) and imprecision. I=intervention; C=comparison; CI=confidence interval | |||||
| «Gosmann NP, Costa MA, Jaeger MB, et al. Incidence of adverse events and comparative tolerability of selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for th»2 | 2 studies (47/45) | 6-26 weeks | - | - | SMD – 0,70 (-1,12 to -0,28) |
References
- Walitt B, Urrútia G, Nishishinya MB, et al. Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database Syst Rev 2015;2015(6):CD011735 «PMID: 26046493»PubMed
- Gosmann NP, Costa MA, Jaeger MB, et al. Incidence of adverse events and comparative tolerability of selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for the treatment of anxiety, obsessive-compulsive, and stress disorders: a systematic review and network meta-analysis. Psychol Med 2023;53(9):3783-3792 «PMID: 37278215»PubMed