Psychiatry - December 2008 - (Page 19)

[the interface] serotonin/norepinephrine reuptake inhibition in the treatment of neuropathic pain. We are not aware of any comparative studies between duloxetine and TCAs. As for side effects, duloxetine may cause nausea, somnolence, dizziness, and fatigue. Comparisons of antidepressants. Based upon the presented data, we have developed a comparison table of these various antidepressants (Table 1). As a caveat, please note that there have been few head-to-head comparisons between TCAs and other types of antidepressants; hence, we have had to rely on some interpretation of these data. The most efficacious antidepressants for the treatment of neuropathic pain appear to be the tertiary-amine TCAs (amitriptyline, doxepin, imipramine), venlafaxine, bupropion, and duloxetine. These appear to be closely followed in efficacy by the secondary-amine TCAs (desipramine, nortriptyline). Modestly effective antidepressants may include the SSRIs paroxetine and citalopram. Ineffective antidepressants include fluoxetine. observation that is highly relevant for both psychiatrists and primary care clinicians. 11. REFERENCES 1. Jackson KC, St. Onge EL. Antidepressant pharmacotherapy: considerations for the pain clinician. Pain Pract. 2003;3:135–143. Sharp J, Keefe B. Psychiatry in chronic pain: a review and update. Curr Psychiatry Rep. 2005;7:213–219. Colombo B, Annovazzi POL, Comi G. Medications for neuropathic pain: current trends. Neurol Sci. 2006;27:S183–189. Wolfe GI, Trivedi JR. Painful peripheral neuropathy and its nonsurgical treatment. Muscle Nerve. 2004;30:3–19. Barrett AM, Lucero MA, Le T, et al. Epidemiology, public health burden, and treatment of diabetic peripheral neuropathic pain: a review. Pain Med. 2007;8:S50–S62. Gallagher RM. Management of neuropathic pain: translating mechanistic advances and evidence-based research into clinical practice. Clin J Pain. 2006;22:S2–S8. Gureje O, Von Korff M, Simon GE, et al. Persistent pain and wellbeing: a World Health Organization study in primary care. JAMA. 1998;280:147–151. Bair MJ, Robinson RL, Katon W, et al. Depression and pain comorbidity: a literature review. Arch Int Med. 2003;163:2433–2445. Sullivan MD, Robinson JP. Antidepressant and anticonvulsant medication for chronic pain. Phys Med Rehabil Clin N Am. 2006;17:381–400. Irving GA. Contemporary assessment and management of neuropathic pain. Neurol. 2005;64:S21-27. 12. 13. 2. 14. 3. 15. 4. 5. 16. 6. Vu T-N H. Current pharmacologic approaches to treating neuropathic pain. Curr Pain Headache Rep. 2004;8:15–18. Reisner L. Antidepressants for chronic neuropathic pain. Curr Pain Headache Rep. 2003;7:24–33. Jann MW, Slade JH. Antidepressant agents for the treatment of chronic pain and depression. Pharmacotherapy. 2007;27:1571–1587. Chong MS, Brandner B. Neuropathic agents and pain: new strategies. Biomed Pharmacother. 2006;60:318–322. Clinical Pharmacology [database online]. Tampa, FL: Gold Standard, Inc.; 2008. http://cp.gsm.com. Revised July 2008. Access date November 20, 2008. Turcotte JE, Debonnel G, de Montigny C, et al. Assessment of the serotonin and norepinephrine reuptake blocking properties of duloxetine in healthy subjects. Neuropsychopharmacol. 2001;24:511–521. CONCLUSIONS Neuropathic pain is a relatively common clinical entity. Given the current diversity of available antidepressant options, many different types appear to be efficacious in the treatment of pain, with the exception of SSRIs. Hopefully, future studies will clarify the genuine role of neurotransmitters in pain modulation as well as the explicit comparative efficacies of the available antidepressants. In addition to their effects on pain, future studies may also take into consideration the effect of antidepressants on the overall quality of life and functioning. It seems clear that antidepressants have an important role in the treatment of neuropathic pain—an 7. 8. 9. AUTHOR AFFILIATIONS: Dr. R. Sansone is a professor in the Departments of Psychiatry and Internal Medicine at Wright State University School of Medicine in Dayton, Ohio, and Director of Psychiatry Education at Kettering Medical Center in Kettering, Ohio; Dr. L. Sansone is a family medicine physician (government service) and Medical Director of the Primary Care Clinic at Wright-Patterson Air Force Base. The views and opinions expressed in this column are those of the authors and do not reflect the official policy or the position of the United States Air Force, Department of Defense, or US government. ADDRESS CORRESPONDENCE TO: Randy A. Sansone, MD, Sycamore Primary Care Center, 2115 Leiter Road, Miamisburg, OH 45342; Phone: (937) 384-6850; Fax: (937) 384-6938; E-mail: Randy.sansone@khnetwork.org 10. [VOLUME 5, NUMBER 12, DECEMBER Psychiatry 2008 19 http://www.clinicalpharmacology.com/

Table of Contents Feed for the Digital Edition of Psychiatry - December 2008

Psychiatry - December 2008 Editor’s Message Contents Editorial Advisory Board Antidepressant Prescribing by Specialty and Treatment of Premenstrual Dysmorphic Disorder Pain, Pain, Go Away: Antidepressants and Pain Management Why Psychotherapy Helps the Patient in Chronic Pain General Medical Drugs Associated with Depression Katatonia: A New Conceptual Understanding of Catatonia and a New Rating Scale Thermoregulation and the Role of Calcium Signalling in Neurotransmission Cognition and Schizophrenia: Is There a Role for Cognitive Assessments in Diagnosis and Treatment? Journal Watch Information for Authors

Psychiatry - December 2008

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