Antidepressant medications
Chronic low back pain is known to cause depression,
and depression makes it more difficult to deal
with pain. Therefore, it is often important for
low back pain and depression to be treated simultaneously
for the treatment to be successful.
The first generation antidepressant medications
(e.g. tricyclics, monoamine oxidase inhibitors)
had significant side effects and are no longer
used to treat depression. However, the tricyclics
(Amytriptiline, Nortriptiline, and Imipramine)
are prescribed in lower doses as sedatives to
help patients with difficulty sleeping. They
are not addictive and do not change a patient’s
sleep cycles, and therefore may be taken on a
long-term basis. Initially, most patients feel
groggy the morning after taking a tricyclic,
but this "hangover" effect typically
goes away quickly. Tricyclic medications also
seem to diminish pain if taken on a regular basis,
although the mechanism for this pain relieving
effect is not known.
A new class of drugs is now used to treat depression:
selective serotonin reuptake inhibitors (SSRI's).
Serotonin is a neurotransmitter in the brain
that affects mood. Examples of SSRI’s include
Prozac, Paxil, Zoloft, and Wellbutrin.
These medications have relatively few side effects.
However, it is important to note that they have
a potentially fatal drug interaction with monoamine
oxidase inhibitors (e.g. Nardil, Parnate, Marplan)
and should not be taken together.
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