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Antidepressants For Chronic Pain

Antidepressants selection for chronic pain

anwerghanijaber
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Antidepressants For Chronic Pain

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  1. Antidepressants For Chronic Pain Anwer Ghani FRIBM Iraq

  2. Antidepressants (ADs) Classes: A-Non-Norepinephrinic 1- Melatonergic (MRAs) 2- Serotonin-antagonist-and-reuptake-inhibitor (SARI) 3-Selective serotonin reuptake inhibitors (SSRIs) 4- 5-HT 2 receptors antagonist (HT2RAs)

  3. Antidepressants (ADs) Classes: B- Norepinephrinic 1- Noradrenergic and specific serotonergic antidepressant (NSSAs) 2- Norepinephrine reuptake inhibitor (NRIs) 3- Selective serotonin and norepinephrine reuptake inhibitor (SSNRI) 4- Norepinephrine-dopamine reuptake inhibitors (NDRIs) 5- Tricyclic antidepressant (TCAs) (serotonin-norepinephrine reuptake inhibitors (SNRIs) (non-selective). 5-Monoamine oxidase inhibitor (MAOIs) serotonin, norepinephrine, and dopamine breakdown inhibitor (SNDBI). 7-Selective monoamine oxidase-B inhibitor (SMAOBIs) serotonin- norepinephrine breakdown inhibitor (SNDBI).

  4. ADs are effective (well-studied) in the following Pain conditions: Diabetic neuropathy IBS Migraine Chronic pain Fibromyalgia

  5. The safety The safety is more important. The safest groups on BP, CV, GIT, SF are: (MRAs)>(SARI) > (SSRIs). Others are less safe or unsafe. All of these drugs are effective in treating chronic pain.

  6. Selection: 1st line: Melatonergic (MRAs) ex: Agomelatine. 2nd line: Serotonin-antagonist-and-reuptake-inhibitor (SARI) ex: Trazodone. 3rd line: Selective serotonin reuptake inhibitors (SSRIs) ex: Sertraline. -Other types better to be avoided. -This selection can also be made in classic uses such as depression and anxiety.

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  12. Notes 1- MRAs and SARIs do not cause weight gain. 2- IBS-C: use SSRI 3- IBS-D: SARI 4- Milnacipran is an SNRI analgesic. 5- Linezolid is a MAOI antibiotic. 6- ADs are not addictive. However, stopping antidepressant treatment abruptly or missing several doses may cause withdrawal-like symptoms.

  13. Thanks

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