The latest analysis indicates that antidepressants are largely ineffective for chronic pain relief. The analysis was based on 156 randomised trials involving over 25,000 participants, and it found that tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs) all had little or no effect on pain relief. The one class that did show some evidence of effectiveness was SNRIs, though even these reduced pain by a modest amount. This conflicts with a 2021 review by the National Institute for Health and Care Excellence (NICE), which suggested that antidepressants were the only class of medicines that doctors should consider for chronic pain.
Cathy Stannard at NHS Gloucestershire Integrated Care Board in Gloucester, UK advises that antidepressants should not be ruled out as some people may still get a benefit, but suggests exploring other options such as exercise or addressing other issues in life that can amplify the impact of long-term pain. She emphasises that there is unlikely to be any pharmacological “magic bullet” for chronic pain.
Overall, the evidence suggests that antidepressants are largely ineffective for chronic pain relief, though SNRIs may be useful for some people. However, other options such as exercise or addressing other issues in life should also be considered.