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Antidepressants for Cancer Pain
Examples
Tricyclic antidepressants
| Generic Name | Brand Name |
|---|---|
| amitriptyline | Limbitrol |
| desipramine | Norpramin |
| doxepin | Silenor |
| imipramine | Tofranil |
| nortriptyline | Aventyl, Pamelor |
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
| Generic Name | Brand Name |
|---|---|
| duloxetine | Cymbalta |
| venlafaxine | Effexor |
Selective serotonin reuptake inhibitors (SSRIs)
| Generic Name | Brand Name |
|---|---|
| fluoxetine | Prozac |
| paroxetine | Paxil |
| sertraline | Zoloft |
How It Works
Antidepressant medicines increase levels of the chemicals produced in the brain to improve your mood. Lower doses relieve pain and may help you sleep.
Why It Is Used
In low doses, antidepressants may relieve chronic pain and pain related to the peripheral nervous system (neuropathic pain), such as cancer pain. They may also cause drowsiness, which may improve sleep and relieve fatigue.
In higher doses, antidepressants can help to relieve symptoms of depression.
How Well It Works
Some people find that low doses of antidepressants help relieve cancer pain. Researchers are still exploring whether and how well antidepressants affect cancer pain. These drugs can improve sleep. This, in turn, may improve your ability to manage your pain.
Side Effects
Different antidepressants have different side effects. If you have severe side effects from one drug, your doctor may give you a different one.
Most side effects decrease over time. They may include:
- Constipation. Make sure you drink enough fluids while you are taking any of these drugs. Most adults should drink between 8 and 10 glasses of water or noncaffeinated beverages each day. Include fruits, vegetables, and fiber in your diet each day.
- Diarrhea.
- Dry mouth.
- Nausea.
- Changes in appetite or weight.
- Nervousness or anxiety.
- Blurred vision or glaucoma that gets worse.
- Drowsiness or insomnia.
- Low blood pressure.
- Tremors and sweating.
- Urinary retention.
- Headache.
- Decreased sex drive, impotence, or difficulty having an orgasm.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
FDA advisory. The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
What To Think About
Do not suddenly stop taking antidepressants. The use of antidepressants should be tapered off slowly and only under the supervision of a doctor. Abruptly stopping antidepressant medicines can cause negative side effects or a relapse into another depression episode.
Studies have found that daily use of SSRIs may increase the risk of bone fracture in adults over age 50. Before taking an SSRI, talk to your doctor about this risk.
Amitriptyline is the most common antidepressant that is used to treat cancer pain. It may cause side effects, such as dry mouth, drowsiness, constipation, or difficulty urinating.
You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.
People with cancer pain and depression are often treated with one of the following:
- Selective serotonin reuptake inhibitor (SSRI), such as sertraline (Zoloft), fluoxetine (Prozac), or paroxetine (Paxil)
- Serotonin and norepinephrine reuptake inhibitor (SNRI), such as venlafaxine (Effexor) or duloxetine (Cymbalta)
- Higher dosage of tricyclic antidepressant than is used for cancer pain alone
SSRIs make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.1
Women who take an SSRI during pregnancy have a slightly higher chance of having a baby with birth defects.
Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.
Last Revised: October 31, 2011
Author: Healthwise Staff
Medical Review: E. Gregory Thompson, MD - Internal Medicine & Michael Seth Rabin, MD - Medical Oncology
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