anxiety is a matter of debate. Possible variables include confusion
between symptoms of the disease and non-specific physical symptoms of
depression or anxiety. If actually present, like many other diseases,
co-occurring depression or anxiety may be secondary to the disease
either because a component of the disease affects those regions of the
brain involved in emotions (frontal lobe) or are simply a normal
response to being sick. Being stigmatized by others could add another
layer of complexity.
CNS Drugs:
1 February 2012 - Volume 26 - Issue 2 - pp 135-153
The Role of Antipsychotics in the Management of Fibromyalgia
Calandre, Elena P.; Rico-Villademoros, Fernando
Abstract
Fibromyalgia is a syndrome characterized by chronic generalized pain
associated with different somatic symptoms, such as sleep
disturbances, fatigue, stiffness, balance problems, hypersensitivity
to physical and psychological environmental stimuli, depression and
anxiety.
It has been estimated to affect roughly the 2-4% of the general
population in most countries studied, and it has been shown to be much
more prevalent in women than in men. Although its pathophysiology is
not yet fully understood, it is known that both genetic and
environmental factors are involved in its development. Fibromyalgia
shares a high degree of co-morbidity with other conditions, including
chronic headache, temporomandibular disorder, irritable bowel
syndrome, major depression, anxiety disorders and chronic fatigue
syndrome.
Therefore, this is a syndrome difficult to treat for which multimodal
treatments including physical exercise, psychological therapies and
pharmacological treatment are recommended. Although different kinds of
drugs have been studied for the treatment of fibromyalgia, the most
widely used drugs that have the higher degree of evidence for efficacy
include the =E12=E4 ligands pregabalin and gabapentin, and the tricyclic
antidepressants (TCAs) and serotonin noradrenaline (norepinephrine)
reuptake inhibitors (SNRIs). However, there is a need to look for
newer additional therapeutic pharmacological options for the treatment
of this complex and disabling disease.
First- and second-generation antipsychotics have shown analgesic
properties both in an experimental setting and in humans, although
most of the available evidence for the treatment of human pain
concerns older antipsychotics and involves clinical trials performed
several decades ago. In addition, several second-generation
antipsychotics, risperidone, olanzapine and quetiapine, have shown
efficacy in the treatment of some anxiety disorders.
Some second-generation antipsychotics, mainly quetiapine, aripiprazole
and amisulpride, have demonstrated antidepressant activity, with
quetiapine approved for the treatment of bipolar depression and
refractory major depression, and aripiprazole approved as an
adjunctive treatment for major depressive disorder. Finally, several
old and new antipsychotics, including promethazine, levopromazine,
olanzapine, quetiapine and ziprasidone, have been shown to improve
sleep parameters in healthy subjects. Each of these properties
suggests that antipsychotics could represent a new potential
alternative for the treatment of fibromyalgia syndrome.
To date, most of the published studies on the use of antipsychotics in
the treatment of fibromyalgia syndrome have been uncontrolled, either
case reports or case series, dealing with olanzapine, quetiapine,
ziprasidone, levopromazine and amisulpride. The studies on olanzapine
and quetiapine have suggested therapeutic efficacy although, in the
case of olanzapine, hampered by tolerability problems.
A double-blind controlled trial, published in 1980, showed that
chlorpromazine increased slow-wave sleep and improved pain and mood
disturbances. More recently, four double-blind controlled studies have
explored the efficacy of quetiapine, either alone or as an add-on
treatment, in fibromyalgia management. None of these trials has yet
been published, although two of them have been presented as congress
communications, both of them suggesting that quetiapine could be a
potential alternative treatment for fibromyalgia.
In summary, the current available evidence suggests that at least some
antipsychotics, specifically quetiapine, could be useful for the
treatment of fibromyalgia and that further studies on the efficacy of
these compounds are worth pursuing.
doi: 10.2165/11597130-000000000-00000
---------------------------------------------
Send posts to CO-CURE@listserv.nodak.edu
Unsubscribe at http://www.co-cure.org/unsub.htm
---------------------------------------------
Co-Cure's purpose is to provide information from across the spectrum of
opinion concerning medical, research and political aspects of ME/CFS and/or
FMS. We take no position on the validity of any specific scientific or
political opinion expressed in Co-Cure posts, and we urge readers to
research the various opinions available before assuming any one
interpretation is definitive. The Co-Cure website <www.co-cure.org> has a
link to our complete archive of posts as well as articles of central
importance to the issues of our community.
---------------------------------------------
