A Cochrane review on SSRI medications to treat fibromyalgia symptoms «Walitt B, Urrútia G, Nishishinya MB, et al. Select...»1 found a small impact on the total symptoms and fibromyalgia-related pain. The average pain decreased by about 14 % in comparison to the control. The impact was similar on the fibromyalgia-related quality of life (i.e. total symptoms). SSRI medications may also decrease depression symptoms (standardized mean difference -0.39, 95 % CI -0,65 to -0,14).
Specific adverse events were not evaluated. However, for treatment of anxiety, SSRI medications increased the risk of nausea (risk difference 11 %), muscle weakness (11 %), somnolence (9 %), dry mouth (7 %), sweating (8 %), loss of libido (7 %), and ejaculation dysfunction (12 %) «Gosmann NP, Costa MA, Jaeger MB, et al. Incidence ...»2.
We downgraded the level of evidence due to study limitations (high dropout rates) and imprecision.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis; FIQ = fibromyalgia impact questionnaire | |||||
| «Walitt B, Urrútia G, Nishishinya MB, et al. Select...»1 | SR/MA | Adults with fibromyalgia | SSRI vs placebo | Mean pain intensity, FIQ | High |
| Reference | Comments |
|---|---|
| «Walitt B, Urrútia G, Nishishinya MB, et al. Select...»1 | High dropout rates. Randomization and blinding ok. |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean change from baseline (sd) I | Mean at follow up C | Mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: low The quality of evidence is downgraded due to study limitations and imprecision. I=intervention; C=comparison; CI=confidence interval *Calculated by reanalysing the provided data. Random-effects meta-analysis. |
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| «Walitt B, Urrútia G, Nishishinya MB, et al. Select...»1 | 7 studies (163/167) | 6-16 weeks | - | 6,21 | SMD – 0,37 (-0,69 to -0,04) MD of -0,89 (-1,66 to -0,1)* Relative decrease -14% (-27 % to -2 %) |
| Reference | Number of studies and number of patients (I/C) | Follow-up time | Mean change from baseline (sd) I | Mean at follow up C | Mean difference (95% CI) |
|---|---|---|---|---|---|
| Level of evidence: very low The quality of evidence is downgraded due to study limitations (large dropout rate and one crossover trial with short washout) and imprecision. I=intervention; C=comparison; CI=confidence interval |
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| «Gosmann NP, Costa MA, Jaeger MB, et al. Incidence ...»2 | 2 studies (47/45) | 6-26 weeks | - | - | SMD – 0,70 (-1,12 to -0,28) |