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Antidepressants work by altering the levels of the chemicals norepinephrine and serotonin. Norepinephrine and serotonin are neurotransmitters, chemicals that act as a messenger that transmit signals between nerve cells.

Antidepressants increase the levels of these chemicals at the nerve endings, thereby strengthening the system that inhibits pain transmission.

Benefits of using antidepressants for the management of chronic pain· Antidepressants may strengthen the body’s own pain fighting mechanisms by increasing the effects of
norepinephrine and serotonin in the nervous system.
· They are not addictive.
· They may increase the effect of other pain relieving medications.
· They may help relieve anxiety and reduce depression.
· They do not cause the gastrointestinal inflammation often associated with other types of pain medication.

There are three categories of antidepressants used for the treatment of pain, Tricyclic Antidepressants (TCAs),
Selective Serotonin Reuptake Inhibitors (SSRIs), and Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs). Each category has certain benefits and as well as contraindications and side effects.Tricyclic Antidepressants (TCAs)

Tricyclic Antidepressants (TCAs) are the most commonly prescribed type. TCAs are most useful in the treatment of pain caused by diabetic neuropathy, post herpetic neuropathy, tension headache, migraine headache, fibromyalgia, and low back pain. Side effects include drowsiness, dry mouth, constipation, weight gain, difficulty with
urination, and changes in blood pressure.

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Antidepressants are often prescribed for the treatment of certain types of chronic pain. This does not mean that
pain is caused by depression, but that the same chemicals that play a key role in depression are also involved in
chronic pain. Antidepressants have proven beneficial and have been used for many years in pain management.

Nerve pain related to migraine headaches, phantom limb and stump pain, low back pain, central pain (following
stroke), fibromyalgia, and neuropathy associated with diabetes and chemotherapy may be reduced with the use of
antidepressants. They are less helpful for acute musculoskeletal pain, such as that caused by sports injuries.
Living with chronic pain can often cause depression. Antidepressants may be useful for people with chronic pain
that are also depressed by helping reduce the perception of pain as well as reducing anxiety and improving sleep.

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