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Skip Navigation. Enter search term. Topic Contents Topic Overview Related Information Credits. Medicines for Depression Depression Medicine Side Effects Depression Medicine: Deciding to Quit Depression: Cost of Medicine Antidepressants: Keeping Your Life in Balance.

Top of the page. Tricyclic antidepressants , such as amitriptyline, desipramine Norpramin , imipramine Tofranil , and nortriptyline Pamelor. Other antidepressants , such as bupropion Wellbutrin , trazodone, venlafaxine Effexor , and mirtazapine Remeron.

For example: If you have trouble sleeping, you may need a medicine to take at bedtime that causes drowsiness. If you have trouble concentrating on daily tasks, you may need a medicine to take during the day that can help with concentration and clear thinking. Credits By Healthwise Staff Primary Medical Reviewer Anne C.

Current as of October 9, The evidence supporting its use is mixed and other drugs may be better suited for treatment particularly FDA-approved fibromyalgia medications like Cymbalta.

Benefits may be felt within three to four weeks. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for fibromyalgia in adults. Cochrane Database Syst Rev. Farag HM, Yunusa I, Goswami H, Sultan I, Doucette JA, Eguale T.

Comparison of amitriptyline and US Food and Drug Administration—approved treatments for fibromyalgia: a systematic review and network meta-analysis. JAMA Netw Open. MedlinePlus Amitriptyline. McClure EW, Daniels RN. Classics in chemical neuroscience: amitriptyline. ACS Chem Neurosci.

Castro Marrero J, Saez-Francas N, Santillo D, Alegre J. Br J Pharmacol. Harte SE, Harris RE, Clauw DJ. The neurobiology of central sensitization. J Appl Behav Res. National Institutes of Health. Quality Care Products LLC.

Amitriptyline hydrochloride tablet, film coated. National Health Service UK. By Adrienne Dellwo Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic.

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By Adrienne Dellwo. Medically reviewed by David Ozeri, MD. Table of Contents View All. Table of Contents. How the Drug Works. For Fibromyalgia.

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And is there any evidence that it can be used to treat ME? But there is no evidence from these trials to indicate that SSRI's are of any benefit. However, I do receive very occasional anecdotal reports from people who have found an SSRI drug like this to be helpful. Finally, SSRI drugs should not be prescribed in combination with tricyclic antidepressant drugs such as amitriptyline.

Serotonin: 9 Questions and Answers October Serotonin acts as a neurotransmitter, a type of chemical that helps relay signals from one area of the brain to another. Serotonin is made via a unique biochemical conversion process. It begins with tryptophan, a building block to proteins.

Cells that make serotonin use tryptophan hydroxylase, a chemical reactor which, when combined with tryptophan, forms 5-hydroxytryptamine, otherwise known as serotonin. As a neurotransmitter, serotonin helps to relay messages from one area of the brain to another. Because of the widespread distribution of its cells, it is believed to influence a variety of psychological and other body functions.

This includes mood, sexual desire and function, appetite, sleep, memory and learning, temperature regulation, and some social behavior. In terms of body function, serotonin can also affect the functioning of the cardiovascular system, muscles, and various elements in the endocrine system.

One systematic review indicated that cyclobenzaprine was more effective for back pain [ 38 ] but was associated with the side effects of drowsiness, dizziness, and dry mouth. Nonpharmacologic interventions for pain vary, and useful modalities include meditation, warm baths, massage, stretching, acupuncture, hydrotherapy, chiropractic, yoga, tai chi, and transcutaneous electrical nerve stimulation [ 14 , 39 ].

The re-educative individual psychotherapy is mainly performed by psychotherapists and the intensive individual psychotherapy is administered by psychiatrists. Our results found the application of all psychotherapy was higher in the CFS cohort since those with psychiatric problems are mostly referred to psychotherapists for re-educative individual psychotherapy.

However, the group psychotherapy is not a first choice for clinicians in Taiwan. With regard to nonpharmaceutical options, cognitive behavioral therapy CBT , a psychotherapy, has been prescribed to patients with CFS. CBT includes relaxation exercises, the development of coping mechanisms, and stress management, and it is an effective treatment for depression and anxiety and eating and panic disorders [ 40 ].

One randomized trial reported that CBT and graded exercise therapy GET were safe for CFS and effective at improving fatigue and functional impairment [ 41 , 42 ]. A 16 week standard individual CBT has been shown to be beneficial in physical function and fatigue [ 43 ].

Furthermore, CBT is the most cost-effective treatment option for CFS [ 44 ]. Although CBT is often used with GET, the program should be discussed with patients to ensure their compliance.

On the other hand, polysomnography PSG , including brainwave examination EEG , eye movements EOG , muscle activity or skeletal muscle activation EMG , and heart rhythm ECG records certain body functions during sleeping, Nonrestorative sleep is a key feature of CFS and is defined as the subjective experience that sleep has not been sufficiently refreshing or restorative [ 45 , 46 ], resulting in increased daytime drowsiness, mental fatigue, and neurocognitive impairment [ 47 ].

PSG is a key tool for detecting these disorders. Patients with more severe symptoms should be routinely screened for PSDs with appropriate questionnaires, a semistructured history interview, and PSG [ 49 ].

Some emerging management strategies for CFS have been proposed in recent years. The fact that drugs targeting immune responses or impaired autoregulation of blood flow was indicated to be effectual in CFS [ 50 ]. We previously discovered that the increased risk of CFS among patients with psoriasis was attenuated by immunomodulatory drugs [ 11 ].

In addition, a small placebo-controlled and open study mentioned that rituximab achieved sustained clinical responses in patients with CFS [ 51 ], and a clinical trial demonstrated that rintatolimod, a restricted toll-like receptor 3 agonist, achieved significant improvements in patients with CFS [ 52 ].

Furthermore, increased levels of several cytokines, including IL-1 and TNF-α, have been positively correlated with fatigue [ 53 ]. These findings provide insight into treating CFS through immune pathways.

Another emerging treatment of CFS is dietary intervention, with one systemic review indicating that nicotinamide adenine dinucleotide hydride, coenzyme Q10, and probiotic supplements relieved CFS symptoms [ 54 ]. These potential mechanisms contribute by increasing adenosine triphosphate production and improving gut microbiota.

Aripiprazole was reported to relieve the symptoms of CFS including fatigue and unrefreshing sleep effectively [ 55 ]. Biofeedback therapy has also demonstrated benefits in the treatment of CFS. Compared with GET, heart rate variability biofeedback therapy has improved quality of life in cases of mental health disorders, including depression, potentially through the enhancement of self-efficacy and self-control [ 56 ].

Our study has some limitations. First, the severity of CFS and efficacy of the treatment were not evaluated in the study because of limited information available in the NHIRD.

Second, some nonpharmaceutical treatments, such as meditation and massage, were not included in our study because they were not included in the database. Fourth, incorrect coding and diagnoses in the database may have resulted in bias in the data analysis; however, such errors may result in considerable penalties for physicians, and hence, they are unlikely.

Moreover, data on Consequently, the diagnoses and codes should be reliable in our study. In our nationwide population-based cohort study, the use of SSRIs, SARIs, SNRIs, TCAs, NDRI, BZD, muscle relaxants, analgesic drugs, psychotherapies and exercise therapies were prescribed significantly more frequently in the CFS cohort than in the control group.

Previous studies have reported these treatments to be effective at relieving the symptoms of CFS and useful for managing related comorbidities.

The data underlying this study is from the National Health Insurance Research database NHIRD. Interested researchers can obtain the data through formal application to the Ministry of Health and Welfare, Taiwan. Komaroff AL. Ann Intern Med.

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Clin Epidemiol. Download references. We would like to extend acknowledgment to Dr. Yu-Chi Yang's material support, and the listed institutes and Department of Medical Research at Mackay Memorial Hospital, and Mackay Medical College for funding support.

This work was supported by the Taiwan Ministry of Health and Welfare Clinical Trial Center MOHWTDU-B , MOST Clinical Trial Consortium for Stroke MOST B , China Medical University Hospital DMR , Tseng-Lien Lin Foundation, Taichung, Taiwan, Mackay Medical College A03 , Department of Medical Research at Mackay Memorial Hospital MMH; MMH; MMH Kam-Hang Leong, Hei-Tung Yip and Chien-Feng Kuo are joint first authors and contributed equally to this paper.

Department of Medicine, Mackay Medical College, New Taipei City, , Taiwan. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, , USA.

Management Office for Health Data, China Medical University Hospital, Taichung City, , Taiwan. Institute of Infectious Disease, Mackay Memorial Hospital, Taipei City, , Taiwan. Department of Nursing, Nursing and Management, MacKay Junior College of Medicine, New Taipei City, , Taiwan.

Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, , Taiwan. Institute of Long-Term Care, Mackay Medical College, New Taipei City, , Taiwan.

Department of Department of Laboratory Medicine, Mackay Memorial Hospital, Taipei, , Taiwan. You can also search for this author in PubMed Google Scholar. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.