ABSTRACT
This chapter discusses the use of antidepressant medications (ADM) in terms of their use for pain/analgesia. Tricyclic antidepressants (TCA) include amitriptyline, nortriptyline, desipramine, imipramine, and doxepin. The most typical indications include neuropathic pain, fibromyalgia, and, in general, any type of chronic pain. These medications work via a blockade of the reuptake of both serotonin and norepinephrine. TCAs should be used with caution with selective serotonin reuptake inhibitors (SSRI), anticholinergic medications, antiarrhythmics, clonidine, lithium, and tramadol. The SSRIs include fluoxetine, paroxetine, and citalopram, escitalopram and sertraline, among others. These medications are not typically sedating, although for some patients they may be, and with the exclusion of those patients, they are energizing. SSRIs specifically blockade serotonin reuptake. They should be used cautiously in patients with a history of seizures. Mirtazapine is an atypical ADM, described as a noradrenergic serotonin-specific antagonist. The drug facilitates enhanced noradrenergic and serotonergic output, which induces analgesia.
