Antidepressants and anti-seizure medications

Some medications commonly prescribed to manage depression and prevent epileptic seizures have also been found to help relieve chronic pain, including back pain, fibromyalgia and diabetes-related nerve pain (diabetic neuropathy). Because chronic pain often worsens depression, antidepressants may doubly benefit pain and mood symptoms.

• Generic (brand) names. Tricyclic antidepressants used in the treatment of chronic pain include amitriptyline and nortriptyline (Pamelor).

  Serotonin and norepinephrine reuptake inhibitors (SNRIs) that may be prescribed to relieve chronic pain include duloxetine (Cymbalta), venlafaxine (Effexor XR, Pristiq) and milnacipran (Fetzima, Savella).

  Anti-seizure medications that are widely used for the treatment of chronic nerve pain, including postherpetic neuralgia and diabetic neuropathy, include gabapentin (Gralise, Neurontin, Horizant) and pregabalin (Lyrica).

• How they work. These drugs may take several weeks before you notice the effects. Anti-seizure medications quiet pain signals from your nerve cells, and may be helpful primarily for stabbing or shooting pain resulting from nerve damage.
• Benefits and risks. Side effects of these medications are generally mild, but may include nausea, dizziness or drowsiness. As a group, antidepressants and anti-seizure medications may, rarely, worsen depression or cause suicidal thoughts. If you notice changes in your thinking patterns or mood while taking these medications, talk with your doctor right away.
• Bottom line. To reduce the risk of side effects, your doctor may start you out on a small amount of these medications and gradually increase the dose. Tricyclic antidepressants can make you drowsy, so your doctor likely will recommend that you take these medications before bedtime.