Use of antidepressants for ME/CFS?

There may be few studies of tricyclics specifically for ME/CFS, that's not the same as there being no evidence for their effects on sleep in general.

e.g.
. 2017 Jun;34:126-133.
doi: 10.1016/j.sleep.2017.03.007. Epub 2017 Mar 27.
Treatment of insomnia with tricyclic antidepressants: a meta-analysis of polysomnographic randomized controlled trials
Yang Liu 1, Xiaomin Xu 1, Meixue Dong 1, Shiyu Jia 1, Youdong Wei 2
Affiliations

• PMID: 28522080
  
• DOI: 10.1016/j.sleep.2017.03.007

Abstract


Background: Insomnia represents a significant public health burden worldwide. Antidepressants have often been the insomnia treatment of choice in recent decades. Some tricyclic antidepressants (TCAs) have been shown to improve sleep efficiency.

Objective: Assess the efficacy and safety of TCAs for the treatment of insomnia using a meta-analysis of randomized control trials (RCTs).

Methods: Relevant studies were identified in electronic databases such as PubMed, Cochrane, Embase, and Web of Science, up until July 2016. We included all polysomnographic (PSG) RCTs using TCAs to treat insomnia. The primary outcome measure was the total sleep time (TST), although other polysomnographic measures were also investigated. Next-day somnolence and dropout rates were also assessed.

Results: The meta-analysis included nine RCTs. TCAs significantly improved TST compared with placebo (SMD = 0.61, 95% CI = 0.50-0.71, P < 0.00001). Participants receiving TCAs were not more likely to drop out than those receiving a placebo because of adverse side effects (1.71% vs 1.19%, RR = 1.37, 95% CI = 0.67-2.80, P = 0.39) or any other reason (7.08% vs 8.20%; RR = 0.86, 95% CI = 0.60-1.23, P = 0.42). However, the incidence of somnolence was higher in participants receiving TCAs (6.06% vs. 3.21%; RR = 1.82, 95% CI = 1.10-3.00, P = 0.02).

Conclusions: Based on our limited data analysis with two medications at particular doses (most studies included extremely low doxepin), we assert that TCAs can be an effective pharmacological treatment for insomnia. TCAs were found to improve sleep outcome measures, with the notable exception of an 82% increase in somnolence. Overall TCAs have very problematic and dangerous side effects, while TCAs were not found to increase the dropout rate compared with the placebo.

Keywords: Insomnia; Meta-analysis; Tricycle antidepressants.

 

file:///Users/barb/Downloads/Antidepressant-withdrawal-and-how-to-taper-safely_Finland.pdf
Slide presentation: "Antidepressant withdrawal syndrome and its management"

Dr Mark Horowitz BA, BSc, MBBS, MSc, PhD (IoPPN, KCL)
Clinical Research Fellow on RADAR trial (UCL, NELFT)
Psychiatry Trainee (Camden & Islington)
m.horowitz@ucl.ac.uk

https://madinfinland.org/wp-content...ithdrawal-and-how-to-taper-safely_Finland.pdf
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'Comment: This looks interesting...."

 

An interesting thing I have noticed is some people who don’t take something for their sleep (like tricyclics) can’t tolerate some posited therapies as they would stimulate them too much.

 

I think many well intentioned doctors do understand that depression isn’t ME/CFS, even though some symptoms on the surface can overlap.

And many also know, and we do too, that having ME for years with non-stop symptoms, possible worsening severity, no effective treatments and little hope that this can cause what is called reactive depression/adjustment disorder/situational depression (I think adjustment disorder is a terrible name). So antidepressants can help here just like eg pain and sleep meds help with those ME caused symptoms. One is possibly indirectly caused by ME and the others directly caused, but in the end makes little difference.

 

It’s probably been said here before, but major depressive disorder (MDD) is extremely common in multiple sclerosis patients. I think it’s one of the most common comorbidities of MS. I’m pretty positive no MS expert knows for sure whether it’s a reactive depression or over time could actually be a cumulative downstream effect of the MS disease process.

I think the same with ME. I know for sure in the beginning and for many years afterwards I didn’t have any symptoms of depression, but I couldn’t tell you if now after more years, with more disease progression and little treatment hope, if some of the depressive symptoms going on with me were caused by the cumulative disease process or simply a reactive, situational depression.

Another reason to not necessarily ignore antidepressants, they won’t solve a lot but can still be useful. Even just to cope with the fact that many of us don’t think we will have an effective treatment before we’re too old to care and will lose most of our adult lives to this.