The combined use of pregabalin and the antidepressant paroxetine is more effective in reducing somatic symptoms and depression in fibromyalgia patients than pregabalin with other relatively new antidepressants, showing both better efficacy and tolerability and reduced side effects, according to the study, “Comparative Efficacy of Newer Antidepressants in Combination with Pregabalin for Fibromyalgia Syndrome: A Controlled, Randomized Study,” published in the journal Pain Practice.
Fibromyalgia is a cause of chronic and widespread, disabling pain in young and middle-age women, and often associated with depression, anxiety, and alexithymia. In 2010, the American College of Rheumatology (ACR) established new diagnostic criteria for fibromyalgia, including a widespread pain index (WPI) and categorical scales for various cognitive and somatic symptoms, poor sleep, and fatigue.
A comparison of long-term efficacy, tolerability, and safety of the concomitant use of pregabalin, an approved fibromyalgia treatment, with the antidepressant medications amitriptyline, venlafaxine, or paroxetine has not been previously studied for this disease.
Eiad A. Ramzy, MBBCh, MD, FIPP Pain Clinic, Department of Anaesthesia and Surgical Intensive Care, Mansoura University in Mansoura, in Egypt, hypothesized that the combined use of pregabalin and paroxetine would result in comparable Somatic Symptoms Scale-8 (SSS-8) and Center for Epidemiological Studies Depression Scale (CESDS) scores, but higher medication tolerability than the use of pregabalin with amitriptyline or venlafaxine.
A total of 75 women with fibromyalgia, taking 75 mg/day of pregabalin, were randomized to receive treatment with amitriptyline (25 mg/day; n = 24), venlafaxine (75 mg/day; n = 25), or paroxetine (25 mg/day; n = 26). All the women were evaluated twice monthly for a period of six months for changes in their SSS-8 and CESDS scores, measures of life satisfaction, tolerability to medication, sleep quality, fatigue, mood, and adverse events.
Results revealed that, compared with pregabalin and amitriptyline or venlafaxine, treatment with pregabalin and paroxetine resulted in lower scores in the SSS-8 and CESDS at 18 and 10 weeks after the study’s initiation. The results also showed that pregabalin and paroxetine resulted in improved tolerability to medication, sleep quality, mood, and life satisfaction, and fewer incidences of elevated blood pressure and reports of dry mouth.
“The combined use of pregabalin plus paroxetine offers an effective method with increased tolerability to reduce the somatic and depressive symptoms of fibromyalgia and to enhance the quality of life in affected individuals,” the authors concluded in their study.