The use of antidepressants in the treatment of back pain

Amitriptyline (Amitriptyline)

Tablets, dragees, capsules, solution for intravenous and intramuscular administration, solution for intramuscular administration, coated tablets

Pharmachologic effect:

Antilepressant (tricyclic antidepressant). It also has some analgesic (central genesis), H2-histamine-blocking and antiserotonin action, contributes to the elimination of urinary incontinence and reduces appetite. Has a strong peripheral and central anticholinergic action due to high affinity for m-holinoretseptoram; a strong sedative effect associated with affinity for H1-histamine receptors, and alpha-adrenoblocking action. Has the properties of antiarrhythmic drug subgroup 1a, like quinidine in therapeutic doses, slows down the ventricular conduction (overdose can cause severe intraventricular blockade).

The mechanism of antidepressant action is associated with an increase in the concentration of noradrenaline in synapses and / or serotonin in the central nervous system (a decrease in their reverse absorption). Accumulation of these neurotransmitters occurs as a result of inhibition of their inverse capture by the membranes of presynaptic neurons. With prolonged use reduces the functional activity of beta-adrenergic and serotonin receptors in the brain, normalizes adrenergic and serotonergic transmission, restores the balance of these systems, disturbed in depressive states. With anxiety-depressive states reduces anxiety, agitation and depressive manifestations.

The mechanism of antiulcer action is due to the ability to block H2-histamine receptors in the parietal cells of the stomach, as well as to provide sedative and m-holin-blocking action (in stomach ulcer and duodenal ulcer relieves pain, promotes the healing of ulcers).

Efficacy for night urinary incontinence is apparently due to anticholinergic activity leading to increased bladder capacity for stretching, direct beta adrenergic stimulation, alpha-adrenergic agonist activity accompanied by increased sphincter tone, and central blockade of serotonin uptake.

The central analgesic effect can be associated with changes in the concentration of monoamines in the central nervous system, especially serotonin, and in the effect on endogenous opioid systems.

The mechanism of action for bulimia nervosa is unclear (it may be similar to that in depression). It shows a distinct effect of the drug with bulimia in patients with both depression and its presence, while a decrease in bulimia can be noted without the concomitant weakening of depression itself.

When conducting general anesthesia reduces blood pressure and body temperature. Does not inhibit MAO. Antidepressant action develops within 2-3 weeks after the beginning of application.

Indications for use.

Depression (especially with anxiety, agitation and sleep disorders, including in childhood, endogenous, involutional, reactive, neurotic, drug, with organic brain lesions, alcohol withdrawal), schizophrenic psychoses, mixed emotional disorders, behavioral disorders (activity and attention ), nocturnal enuresis (except for patients with bladder hypotension), bulimia nervosa, chronic pain syndrome (chronic pain in cancer patients, migraine, rheumatic diseases, atypical pain in facial area, postherpetic neuralgia, posttraumatic neuropathy, diabetic or other peripheral neuropathy), headache, migraine (prophylaxis), peptic ulcer and duodenal ulcer.

[1], [2], [3], [4], [5], [6]

Venlafaxine (Venlafaxine)

Tablets, prolonged-action capsules, modified-release capsules

Pharmachologic effect

Antidepressant. Venlafaxine and its main metabolite, O-desmethylvenlafaxine, are potent inhibitors of serotonin and noradrenaline reuptake and weak inhibitors of dopamine reuptake. It is believed that the mechanism of antidepressant action is associated with the ability of the drug to enhance the transmission of nerve impulses in the central nervous system. On the inhibition of reuptake of serotonin, venlafaxine is inferior to selective serotonin reuptake inhibitors.

Indications for use

Depression (treatment, prevention of relapse).

Duloxetine (Duloxetine)

Capsules

Pharmachologic effect

Inhibits the reverse capture of serotonin and noadrenaline, resulting in increased serotonergic and noradrenergic neurotransmission in the central nervous system. Weakly inhibits the capture of dopamine, without having a significant affinity for histaminergic, dopaminergic, cholinergic and adrenergic receptors.

Duloxetine has a central mechanism for suppressing the pain syndrome, which is primarily manifested by an increase in the threshold of pain sensitivity in the pain syndrome of neuropathic etiology.

Indications for use

Depression, diabetic peripheral neuropathy (painful form).

[7], [8], [9], [10]

Fluoxetine (Fluoxetine)

Pills

Pharmachologic effect

Antidepressant, selective serotonin reuptake inhibitor. Improves mood, reduces tension, anxiety and fear, eliminates dysphoria. Does not cause orthostatic hypotension, sedation, non-cardiotoxic. A persistent clinical effect occurs after 1-2 weeks of treatment

Indications for use

Depression, bulimic neurosis, obsessive-compulsive disorder, premenstrual dysphoria.

[11], [12], [13], [14], [15], [16], [17], [18], [19], [20]