Antidepressants

Abstract

These are the most effective medications for the neuropathic pain (NNT 3.1). They also help with depression associated with pain. The most commonly used drugs are amitriptyline, imipramine, nortriptyline, desipramine and clomipramine. They have a three-ring structure with a side chain. They inhibit norepinephrine transport and inhibit reuptake of serotonin. They have selective affinity for α1 receptors. As the reuptake is inhibited, serotonin levels rise and indirect transmission of serotonin is mediated by α2 and D2 receptors. They also block sodium channels, histamine channels and calcium channels. Clinical improvement in pain takes between 2 and 3 weeks after the start of the medication.