Doctors commonly prescribe antidepressants as an off-label treatment for chronic and other types of pain management. However, recent evidence suggests that antidepressants may not always be an effective option for managing pain.

About 20% of adults in the United States are living with chronic pain, according to the Centers for Disease Control and Prevention (CDC). Around 7.4% miss work due to pain. Chronic pain is also associated with a lower quality of life, mental health issues, and opioid addiction.

Due to quality of life issues as well as difficulty in treating pain, doctors often look to other methods to help people manage their pain. This can include the use of antidepressants as an off-label treatment. Off-label means that a doctor prescribes or recommends a medication not initially intended to treat the condition.

This article reviews antidepressants and pain management. It also discusses types of antidepressants, other treatments for chronic pain, and when to contact a doctor.

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Doctors commonly prescribe antidepressants for neuropathic pain as well as chronic pain relief.

Neuropathic pain or chronic nerve pain is associated with nerve damage and other issues with the nerves. A doctor may prescribe a type of antidepressant known as a tricyclic antidepressant to help manage the pain. One of the more common ones used is amitriptyline.

Chronic pain can result from a variety of causes, including injury, illness, and arthritis, among others. Antidepressants may also not be as effective in treating non-neuropathic pain. However, doctors may still prescribe antidepressants such as:

  • tricyclic antidepressants
  • selective serotonin reuptake inhibitors (SSRIs)
  • serotonin-noradrenaline reuptake inhibitors (SNRIs)

In a recent review of studies from 2023, researchers reviewed 26 studies looking at the effectiveness of using antidepressants for pain. They found that in most cases, antidepressants are not effective in treating chronic pain. The researchers recommended that doctors take a more nuanced approach to treatment with antidepressants for pain.

Read about neuropathic pain.

There are several types of antidepressants that a doctor may prescribe for pain. They include:

  • tricyclic antidepressants
  • SSRIs
  • SNRIs

Tricyclic antidepressants, such as amitriptyline, may be prescribed for chronic nerve pain. All three may work for non-nerve-related pain.

Evidence suggests the following effectiveness of each type of antidepressant for pain:

  • SNRIs: SNRIs, such as duloxetine (Cymbalta), may work for chronic back pain, postoperative pain, fibromyalgia, and neuropathic pain as well as depression with chronic pain.
  • SSRIs: SSRIs may help with depression with comorbid pain, but it is likely not effective for other types of pain including back pain, fibromyalgia, functional dyspepsia, and noncardiac chest pain. Some examples include paroxetine (Paxil) and fluoxetine (Prozac, Sarafem).
  • Tricyclic antidepressants: Tricyclic antidepressants, such as amitriptyline, clomipramine, or doxepin, may help with nerve pain, irritable bowel syndrome, and chronic tension headaches. It is not as effective for mechanical causes of pain.

Learn more about antidepressants.

Chronic pain has several possible causes which can affect treatment options. According to the Centers for Disease Control and Prevention (CDC), available non-opioid options for chronic pain include:

  • acetaminophen
  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin
  • gabapentin or pregabalin
  • topical creams and ointments, which may include NSAIDs, capsaicin, or lidocaine

Opioids are a stronger type of pain medication that a doctor may recommend in some cases. However, due to their addictive qualities and side effects, people as well as doctors may not want to use them for long-term periods.

All medications, including over-the-counter medications, can cause side effects. It is important to work with a doctor to help determine the most effective treatment plan and use of medications.

Other treatment options can include:

  • procedures, which may include nerve-blocking procedures or correcting a mechanical issue
  • physical therapy, which includes exercises to build up or stretch muscles to help ease pain
  • complementary therapies, which may include yoga, acupuncture, and meditation
  • lifestyle changes, which may include may include maintaining a moderate weight, exercising, or changes to diet

A person may want to contact a doctor if their pain interferes with their daily life. This may include:

  • missing work
  • inability to complete self-care tasks
  • missing school
  • not being able to participate in exercise or sports
  • pain keeping them up at night

A doctor can help determine the underlying cause of the pain. Proper diagnosis can help make a difference in the types of treatment a doctor recommends.

Diagnosis can vary based on a doctor’s specialty as well as what they believe may be causing the pain. They may review a person’s symptoms, family, and medical history. They also will likely order additional testing that may include imaging tests or blood tests to help discover the underlying cause.

Treatment can vary due to the underlying condition and based on what the doctor believes is the best course of action. Experts note there is no singular way to treat chronic pain.

Instead, a person and a doctor will need to work together to determine what treatments and supports are most effective for them.

Antidepressants may provide effective pain relief for some people. Some evidence suggests that the widespread use of antidepressants for pain management may not be the most effective treatment and may require doctors to take each case individually.

Chronic pain management can be a challenge for doctors and people seeking treatment. This can lead people to look for complementary and at-home remedies in addition to medical treatments.

A person may have the best success by working with a doctor to determine the most effective treatments for them.