• Posted September 20, 2024

Are Antidepressants Being Overused to Treat Seniors' Pain?

Doctors sometimes turn to antidepressants as a means of easing older people's physical pain, but a new expert review finds there's little evidence to support the practice.

Antidepressants may even come with hazards for seniors who don't need them, said researchers from the University of Sydney in Australia.

"Harms of antidepressant use in older people are well documented," said study senior author Dr. Christina Abdel Shaheed.

Her team found that, compared to older folks using other methods to ease pain, those on antidepressants had higher risks for falling, dizziness and injury.

“These medicines are being prescribed to remedy patients' pain, despite the lack of evidence to adequately inform their use,” said Abdel Shaheed, an associate professor in the university’s School of Public Health and the Institute for Musculoskeletal Health.

The findings were published recently in the British Journal of Clinical Pharmacology.

According to the researchers, over the past 40 years there have been only 15 trials worldwide that focused on the use of antidepressants for physical pain in people over the age of 65.

Poring over the data from these studies, the Sydney team found little evidence to support the use of the drugs to ease pain in seniors.

Standard international guidelines do support the use of antidepressants for chronic pain generally, but the data those guidelines are based on did not focus on patients in their senior years.

That could lead to misinformed decisions by doctors, said study lead author Dr. Sujita Narayan.

“If I am a busy clinician and want to look at the guidelines for quick reference, I will probably have time to look at only the key points regarding management of chronic pain, some of which advise the use of antidepressants,” explained Narayan, a research fellow at the university’s Institute for Musculoskeletal Health.

On top of the potential harms from antidepressants, people who took them for pain were more likely to quit using them, compared to other forms of medication. And that comes with its own dangers, the researchers warned.

“Withdrawal from antidepressants can be as bad as withdrawal from opioids," Narayan explained in a university news release. "I would recommend that anyone considering discontinuing their medication to not stop taking their antidepressants immediately, but to consult with their clinician and devise a tapering plan, as necessary."

While most of the studies found antidepressants largely ineffective in easing pain in seniors, there was one exception: Knee pain linked to arthritis treated with duloxetine (Cymbalta).

But even that benefit was time-specific.

“There was higher quality evidence on its efficacy for chronic pain related to knee osteoarthritis," Narayan said. "This was based on using it for a period of roughly two to four months. It wasn't significant in the immediate term, if used for up to two weeks, and no data was available for use beyond a 12-month period."

“For clinicians and patients who might be using or considering duloxetine for knee osteoarthritis, the message is clear: benefits may be seen with a little persistence, but the effects may be small and need to be weighed up against the risk,” Narayan concluded.

She and Abdel Shaheed noted that most of the trials focused on antidepressants and pain relief guidelines were small, averaging less than 100 participants.

"The key point is that we shouldn't rely on findings from studies with younger people and apply them to older adults because they are different, older people’s bodies undergo changes that alter how they respond to medications," Narayan said. "This can lead to different effects in older people compared to younger people."

More information

Find out more about the treatment of arthritis pain at the Arthritis Foundation.

SOURCE: University of Sydney, news release, Sept. 15, 2024