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Amitriptyline for the treatment of depression

Amitriptyline is a tricyclic antidepressant drug that has been used for decades in the treatment of depression. The current review includes 39 trials with a total of 3509 participants and confirms its efficacy compared to placebo or no treatment. This finding is important, because the efficacy of antidepressants has recently been questioned. However, the review also demonstrated that amitriptyline produces a number of side effects such as vision problems, constipation and sedation. It is a limitation of this review that many studies have been poorly reported, which might have led to bias.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Amitriptyline for depression

Amitriptyline still has a place in the pharmacological management of depressive episodes. The findings of this systematic review showed that in comparison with control agents, amitriptyline was slightly more effective, but the burden of side‐effects was greater for patients receiving it.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Amitriptyline for neuropathic pain in adults

Neuropathic pain is pain coming from damaged nerves, and can have a variety of different names. Some of the more common are painful diabetic neuropathy, postherpetic neuralgia, or post‐stroke pain. It is different from pain messages that are carried along healthy nerves from damaged tissue (for example, a fall, or cut, or arthritic knee). Neuropathic pain is treated by different medicines to those used for pain from damaged tissue. Medicines such as paracetamol or ibuprofen are not usually effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Amitriptyline for fibromyalgia in adults

Our understanding of fibromyalgia (a condition of persistent, widespread pain and tenderness, sleep problems, and fatigue) is poor. Common pain relieving medicines such as paracetamol and ibuprofen are not usually considered effective in fibromyalgia. Medicines that are sometimes used to treat epilepsy or depression can be very effective in some people with fibromyalgia, as they are in some other forms of chronic pain where there may be nerve damage (neuropathic pain).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Cyclobenzaprine drug treatment for myofascial pain in adults

Myofascial pain (MP) is a painful condition of the muscles characterized by pain transmitted from trigger points (TP) within connective tissue surrounding and separating muscles (myofascial structures). TP can be located where the pain is felt, or can be at a distance from it. Cyclobenzaprine, one of the drugs used to treat MP, is taken as a pill. It is a muscle relaxant, particularly used to improve quality of sleep and to reduce pain. It suppresses muscle spasms ‐ and so may prevent pain caused by MP ‐ without interfering with muscle function. The purpose of this review was to assess how effective cyclobenzaprine is at reducing pain and improving sleep in patients with MP. We searched extensively through scientific publications and found two trials, with a total of 79 participants. These tested cyclobenzaprine against another drug called clonazepam, and fake medication (placebo), or against injections of a local anesthetic called lidocaine. A total of 35 of the 79 participants in the two trials were given cyclobenzaprine. Cyclobenzaprine was slightly better than clonazepam and placebo at reducing jaw pain, but was no better at improving sleep quality. The results from the other trial were not scientifically reliable because of the small number of participants involved, but lidocaine injections seemed to reduce pain slightly better than cyclobenzaprine pills. Despite this result, it is likely that, because it is uncomfortable to receive any form of injection, people who suffer from MP will prefer to be treated with cyclobenzaprine pills. There were no life‐threatening adverse events associated with any of the medications studied. Further studies are needed to show whether cyclobenzaprine really works for treating MP, but at the moment doctors cannot say whether it is really useful.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antidepressants for patients with tinnitus

Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation, and it is frequently associated with depression or depressive symptoms. Six studies involving a total of 610 patients matched the inclusion criteria for this review. Four evaluated three tricyclic antidepressant agents (amitriptyline, nortriptyline and trimipramine) for the treatment of tinnitus. These studies did not find enough evidence to prove the efficacy of these agents in the management of tinnitus. One study evaluated paroxetine, a selective serotonin reuptake inhibitor antidepressant, and one evaluated trazodone, an atypical antidepressant. Neither of these studies showed benefit of paroxetine or trazodone in the treatment of tinnitus. Side effects, though relatively minor, were common in all groups of antidepressants. Further research is required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antidepressants for the treatment of children and adolescents with functional abdominal pain

Abdominal pain‐related functional gastrointestinal disorders (FGIDs) are common in childhood and adolescence. In most cases no medical reason for the pain can be found. Various drug treatment approaches for the different types of abdominal pain‐related FGIDs exist. These drug treatments include: prokinetics and antisecretory agents for functional dyspepsia; pizotifen, propranolol, cyproheptadine or sumatriptane for abdominal migraine; and antispasmodic and antidiarrhoeal regimen for irritable bowel syndrome. Antidepressants have been shown to be effective in some studies of adults with functional gastrointestinal disorders. As a result young patients with similar complaints are sometimes treated with antidepressants. The purpose of this review was to examine the evidence assessing the advantages and disadvantages of such an approach. Only two studies met the inclusion criteria. Both of these studies were randomised controlled trials and assessed the effectiveness and safety of amitriptyline in children with FGIDs. Amitriptyline is a first generation antidepressant (tricyclic antidepressant). Amitriptyline is no longer an agent of first choice for the treatment of depressive disorders because of potentially serious side effects including overdose. Amitriptyline has not been approved for the treatment of functional abdominal pain in children or adolescents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Drugs other than those used for epilepsy for treating trigeminal neuralgia

The purpose of this review was to assess the effects of non‐antiepileptic drugs in trigeminal neuralgia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Comparing Fibromyalgia Drugs

How do drugs for fibromyalgia compare in improving symptoms?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: June 12, 2011

Antipsychotics for fibromyalgia symptoms in adults

Quetiapine may be considered for 4 to 12 weeks to reduce pain, sleep problems, depression and anxiety in fibromyalgia patients with major depression. Potential side effects such as weight gain should be balanced against the potential benefits.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Cannabis products for people with fibromyalgia

Fibromyalgia is characterised by chronic (longer than three months) widespread pain that often co‐exists with sleep problems, problems with thinking and fatigue (exhaustion). People often report severe limitations of daily functioning and poor health‐related quality of life. Therapies focus on reducing key symptoms and disability, and improving health‐related quality of life. Cannabis has been used for 3000 years to reduce pain and other symptoms, such as loss of appetite and anxiety.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Pharmacotherapy for tooth grinding or clenching during the sleep (sleep bruxism)

There are several signs and symptoms of sleep bruxism, such as abnormal tooth wear, fractured teeth, jaw muscle discomfort, joint pain or tenderness, and headaches. Treatments include odontological devices such as occlusal splints, psychotherapy and medications (pharmacotherapy). Pharmacological treatments include drugs such as benzodiazepines, anticonvulsants, beta‐blockers, dopamine agents, antidepressants, muscle relaxants and others. However, little is known about the effectiveness, safety and long‐term follow‐up of medications for sleep bruxism.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Nortriptyline for neuropathic pain in adults

Neuropathic pain is pain coming from damaged nerves. It is different from pain messages that are carried along healthy nerves from damaged tissue (for example, a fall, or cut, or arthritic knee). Neuropathic pain is treated by different medicines to those used for pain from damaged tissue. Medicines such as paracetamol or ibuprofen are not usually effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Anti‐depressant therapies may be able to help relieve depression in people with Parkinson's disease but more research is needed on safety and effectiveness.

Parkinson's disease can lead to psychiatric as well as physical symptoms, the most common of which is depression. Oral antidepressants, electroconvulsive therapy or behavioural therapy are currently used in the treatment of depression in Parkinson's disease. No trials were found examining the efficacy of electroconvulsive therapy or behavioural therapy. We identified three trials which examined antidepressant drugs. The review found that there is not enough evidence from the trials about the effects of antidepressant drugs for the treatment of depression in people with Parkinson's disease. Adverse effects in trials so far have not been severe, and included visual hallucinations and confusion.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Selective serotonin reuptake inhibitors (SSRIs) and serotonin‐norepinephrine reuptake inhibitors (SNRIs) for preventing tension‐type headache

Tension‐type headache is a common type of headache that can significantly impair people's quality of life. Individuals who experience frequent or severe headaches may benefit from medications taken before the pain starts. Two classes of medication, the selective serotonin reuptake inhibitors (SSRIs) and serotonin‐norepinephrine reuptake inhibitors (SNRIs), typically used to treat depression, are evaluated in this review.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Selective serotonin reuptake inhibitors (SSRIs) and serotonin‐norepinephrine reuptake inhibitors (SNRIs) for preventing migraine

Migraine is a common condition that can significantly impair people's quality of life. Individuals who experience frequent or severe migraine may benefit from preventive medications taken prior to an attack and before the pain starts. Studies have suggested the potential role of neurotransmitters in the genesis of headache. Accordingly, drugs that inhibit the passage of neurotransmitters in brain cells and, therefore, increase their levels, have been examined for their potential benefit in preventing migraine. Two classes of inhibitors, the selective serotonin reuptake inhibitors (SSRIs) and serotonin‐norepinephrine reuptake inhibitors (SNRIs), typically used to treat depression, are evaluated in this review.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Antidepressants for treating neuropathic pain

A number of medicines used to treat depression (antidepressants) are effective in treating pain associated with nerve damage (neuropathic pain). At least one third of patients with neuropathic pain who took traditional antidepressants (such as amitriptyline) obtained moderate pain relief or better. There is also evidence that Venlafaxine, a newer antidepressant, has similar effectiveness to traditional antidepressants. However, approximately one fifth of those who take these medicines for pain discontinue the therapy due to adverse effects. There is very limited evidence that some other newer antidepressants, known as SSRIs, may be effective but more studies are needed to confirm this. Neuropathic pain can be treated with antidepressants and the effect is independent of any effect on depression.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Imipramine for neuropathic pain in adults

Neuropathic pain is pain coming from damaged nerves. It is different from pain messages carried along healthy nerves from damaged tissue (as in a fall, a cut, or an arthritic knee). Neuropathic pain is treated with different medicines than pain from damaged tissue. Medicines like paracetamol or ibuprofen are usually not effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Desipramine for neuropathic pain in adults

Neuropathic pain is pain coming from damaged nerves. It is different from pain messages carried along healthy nerves from damaged tissue (a fall, cut, or arthritic knee). Neuropathic pain is treated by different medicines than pain from damaged tissue. Medicines like paracetamol or ibuprofen are not usually effective in neuropathic pain, while medicines that are sometimes used to treat depression or epilepsy can be very effective in some people with neuropathic pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Simple treatments for bedwetting in children

Bedwetting (nocturnal enuresis) is the involuntary loss of urine at night without an underlying organic disease as the cause. It can result in issues of psychosocial well‐being such as social problems, sibling teasing and lowered self esteem. It affects around 15% to 20% of five year olds and up to 2% of adults.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

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