Antidepressants may help in reducing the pain and fatigue associated with fibromyalgia. The antidepressants duloxetine and milnacipran are routinely used for this purpose, and they might be prescribed together with amitriptyline or cyclobenzaprine (a muscle relaxant) to help patients sleep more easily. Patients taking antidepressants should be monitored regularly, especially during the first three months of treatment. Doctors should ask about the patient's mood, and patients should inform their healthcare provider immediately if they develop any suicidal thoughts, panic attacks, or worrying changes in behavior.
Potential side effects of duloxetine include sweating, nausea, loss of appetite, diarrhea, constipation, and dry mouth. Some patients could develop headaches, muscle aches, heartburn, or increased urination. Individuals taking milnacipran may experience hot flashes, swelling in the hands and feet, insomnia, and changes in weight. Bloating, upset stomach, and nausea have been reported as well. Patients taking antidepressants should make sure they are informed about all potential side effects of their particular medication, and they may wish to keep a diary of any symptoms or unusual side effects that they experience. If a particular antidepressant causes troublesome side effects or does not seem to sufficiently reduce fibromyalgia pain, the patient's physician may be able to prescribe another antidepressant better suited to the patient's needs.
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