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The use of medication in the treatment of fibromyalgia is debated, [18] [19] although antidepressants can improve quality of life. [20] Other medications commonly considered helpful in managing fibromyalgia include serotonin–norepinephrine reuptake inhibitors, nonsteroidal anti-inflammatory drugs, and muscle relaxants. [21]
Shown to be significantly effective in the treatment of depression and fibromyalgia. [15] The Food and Drug Administration (FDA) approved milnacipran for treatment of fibromyalgia in the United States in January 2009, however it is not approved for depression in that country.
The National Institute for Clinical and Health Excellence recommends (as of September 2013) that duloxetine not be routinely offered as first-line treatment, and that it only be offered as second-line therapy in women wishing to avoid therapy. The guideline further states that women should be counseled regarding the drug's side effects. [53]
The symptoms and the treatment of an overdose are largely the same as for the other TCAs, including the presentation of serotonin syndrome and adverse cardiac effects. The British National Formulary notes that amitriptyline can be particularly dangerous in overdose, [ 70 ] thus it and other TCAs are no longer recommended as first-line therapy ...
Discontinuation of treatment due to side effects was common. [64] Antidepressants including amitriptyline, fluoxetine, duloxetine, milnacipran, moclobemide, and pirlindole are recommended by the European League Against Rheumatism (EULAR) for the treatment of fibromyalgia based on "limited evidence". [65]
Tianeptine also has anticonvulsant and analgesic effects, [31] and a clinical trial in Spain that ended in January 2007 has shown that tianeptine is effective in treating pain due to fibromyalgia. [32] Tianeptine has been shown to have efficacy with minimal side effects in the treatment of attention-deficit hyperactivity disorder. [33]
Milnacipran (trade names Ixel, Savella, Dalcipran, Toledomin) is a serotonin–norepinephrine reuptake inhibitor (SNRI) used in the clinical treatment of fibromyalgia. It is not approved for the clinical treatment of major depressive disorder in the US, but it is in other countries.
[12] [33]: 57 Finally, sleep disorders, coeliac disease, and side effects of medications may also explain symptoms. [12] Joint and muscle pain without swelling or inflammation is a common feature of ME/CFS, but is more closely associated with fibromyalgia. Modern definitions of fibromyalgia not only include widespread pain but also fatigue ...