Antidepressants and Pain Management

Most of the drugs that are used in psychiatry are also used as pain medications. These drugs are known for anxiety treatment, reducing fatigue, insomnia, depression, Also benzodiazepines, or anticonvulsants can be used to relieve pain. Of the most common psychiatric drugs, those that are antidepressants also have a pain reducing effect. This is through to be partly independent of the relieving effect on depression.
The two main classes of antidepressants, which are known as the tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), are thought to play different roles when it comes to treating pain. The drug amitriptyline (Elavil), is a tricyclic. It is also one of the most prescribed antidepressants that is also used as an analgesic. This is due, partly, to its sedative abilities, which can be beneficial for people who may be in pain. The SSRIs like fluoxetine (Prozac) as well as sertraline (Zoloft) are not normally as effective when it comes to pain relief. However, their known side effects can often be better tolerated by patients. They are also less risky when compared to the tricyclic drugs. For both of these drug classes, they work on brain pathways which are known to regulate mood as well as pain perception. The tricyclics medications will increase the activity that goes on with the neurotransmitters norepinephrine as well as serotonin. When it comes to the SSRIs, they work more on serotonin. There are researchers as well as some clinicians who believe the newer antidepressant drugs act more strongly on neurotransmitters. These are known as dual action drugs such as venlafaxine (Effexor), which is believed to be superior to the tricyclics and SSRIs when it comes to treating pain. To date, though, the evidence is not conclusive.
Many physicians and some clinical psychiatrists are also thinking over the possible potential of the drug gabapentin (Neurontin). They are also looking at drugs that can effectively block the normal activity of substance P. This is yet another neurotransmitter that is involved in pain regulation and depression. In addition, electroconvulsive therapy, which has been a standard treatment in cases of severe depression, can also have analgesic effects.
Tricyclic antidepressants have long been used in treating mild-to-moderate pain that is also associated with neuropathy. These drugs work by increasing levels of neurotransmitters that are found in the brain tissue and by inhibiting certain chemical processes that are also found in the human brain which lets us feel pain. Many times, these medications are used in conjunction with either non-narcotic or sometimes narcotic pain relievers for pain management.
The well-known tricyclic antidepressants appear to be more effective for pain that is brought about by diabetic nerve damage, tension headache, or the more severe migraine, as well as fibromyalgia, and cases of low back pain.
It is not yet fully understood how the painkilling mechanism works in these drugs. It is thought that the tricyclic antidepressants can somehow increase neurotransmitters within the spinal cord which are known to reduce the pain signals. However, these drugs do not work right away. In most cases, patients must take tricyclic antidepressants for many weeks before they notice a reduction in pain.
There are some side effects for tricyclic antidepressants including:
  • dry mouth
  • drowsiness
  • constipation
  • sudden weight gain
  • blood pressure changes.
Selective serotonin reuptake inhibitors are the newer forms of antidepressants that are being used today to treat pain symptoms that are caused by neuropathy. The SSRIs are able to restore chemical balances within the human brain's nerve cells.
Serotonin and norepinephrine reuptake inhibitors comprise a relatively new form of antidepressant that may also alleviate pain that is caused by neuropathy. This newer from of drug works on the nerve cells within the human brain and inhibits not only the production but also the release of specific neurotransmitters. These are being serotonin and norepinephrine.
Another type of antidressant is the Serotonin and norepinephrine reuptake inhibitors (SNRIs). These, too, can be used to reduce neuropathic pain. The drugs work on the nerve cells that are located in the brain and restrict the reuse of certain neurotransmitters such as dopamine, serotonin, or norepinephrine. It is also used to help alleviate depression by balancing brain chemicals.
Serotonin receptor modulators is a class of antidepressant medications which may also be used to relieve neuropathic pain. The drugs work by restoring proper balance to certain brain chemicals. They do this by increasing overall levels of both serotonin and norepinephrine, which are used to transmit messages within the brain to other nerves.
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