Millions of People Are Prescribed Antidepressants for Pain Every Year – Despite ‘Shocking’ Lack of Evidence That Powerful Drugs Work, Study Claims
Millions of antidepressants are being dished out for chronic pain each year despite little evidence they work, a major scientific review found. An investigation into medications to manage long-term pain found that the harms of many of the commonly recommended drugs are poorly researched. Yet around 10 million prescriptions for drugs including amitriptyline and fluoxetine, more commonly known as Prozac, were dished out in the last 12 months for long-term pain management.
Scientists said there was a ‘shocking’ lack of evidence around the long-term effects of taking antidepressants, leaving hundreds of thousands of people at significant risk of harm. They urged doctors to prioritise medications for which there is some evidence of effectiveness and to focus on more ‘holistic’ therapies – such as lifestyle changes.
With around one in three people suffering from chronic pain, antidepressant use is increasing as doctors seek to alleviate symptoms without using potentially addictive opioids. Other medications such as paracetamol and ibuprofen are now deemed both ineffective and potentially damaging, leaving GPs with limited options.
The two-year Cochrane study was the largest-ever assessment of antidepressants recommended by leading bodies including the UK’s National Institute for Health and Care Excellence (NICE). The ‘gold standard’ review, it looked at 176 studies involving almost 30,000 people and 89 treatment types ranging from various types of antidepressants to psychological therapies and physiotherapy.
Despite commonly being prescribed for six months, the Cochrane Review found the average trial length was just 10 weeks. It found there was ‘insufficient evidence’ to determine either how effective or harmful most antidepressants are, with scientists particularly concerned over the lack of research into long-term use.
Duloxetine was consistently the highest scoring for relieving pain and was found to be equally effective for fibromyalgia, musculoskeletal, and neuropathic pain conditions, which are eligible for the drugs under NICE guidelines. Milnacipran was also effective at reducing pain, but scientists were less confident in the research as there were fewer studies involving substantially fewer people.
Amitriptyline is one of the most commonly 3 prescribed antidepressants for pain management worldwide, with researchers suggesting it is the ‘go-to’ drug for GPs as it is cheap – costing around 69 pence a dose. In the last 12 months, around ten million prescriptions were given to patients in England at the 10mg dose recommended for pain. By comparison, five million prescriptions were given at the higher doses recommended for depression. Some 3.5 million prescriptions were dispensed in England for duloxetine but only come in one dose for all conditions, despite lower doses being found to be just as effective.
Drugs watchdog NICE said there were no plans to change guidelines based on the review, noting that its guidelines state GPs should only ‘consider’ offering antidepressants. It said the 2021 guidelines recommend antidepressants, including duloxetine, can be considered for people aged 18 years and over to manage chronic primary pain ‘after a full discussion of the benefits and harms’. They said the evidence shows these medicines may help with the quality of life, pain, sleep and psychological distress, even in the absence of a diagnosis of depression.
