Antidepressants are typically prescribed to manage depression . But this isn't the only reason you may be prescribed an antidepressant. In fact, they can have a broad range of effects, which makes them suitable for managing a range of other health conditions that aren't necessarily related to mental health.
Author
- Dipa Kamdar
Senior Lecturer in Pharmacy Practice, Kingston University
Here are five health conditions you may be prescribed an antidepressant for.
1. Chronic nerve pain
Many antidepressants are believed to work by increasing the levels of chemicals in the brain called neurotransmitters - although the exact science is still unknown. In particular, they increase levels of serotonin and noradrenaline , which are linked to mood.
These neurotransmitters are also linked to pain pathways . It's for this reason that some people who experience nerve pain may be prescribed a tricyclic antidepressant - such as amitriptyline and nortriptyline .
Studies show that low doses of these drugs may be effective in treating nerve pain. This pain is often described as a shooting, burning pain, which may radiate outwards.
Sometimes patients also experience tingling and numbness. This type of pain is typically caused by nerve damage. Nerve pain can occur in people with diabetes ( diabetic neuropathy ), trigeminal neuralgia (facial pain) and multiple sclerosis .
Studies show these antidepressants are more likely to relieve nerve pain compared to traditional painkillers such as ibuprofen or paracetamol. Duloxetine is another antidepressant that may be used.
Amitriptyline is also sometimes used to prevent migraines , chronic tension headaches and to treat abdominal pain in irritable bowel syndrome .
2. Urinary incontinence
Antidepressants may also be helpful in managing urinary incontinence (unintentionally passing urine) and stress incontinence (passing urine when there's pressure on the bladder from coughing, jumping, laughing or sneezing).
In clinical trials of the antidepressant duloxetine (a serotonin noradrenaline reuptake inhibitor, or SNRI), the drug is shown to be useful in treating severe urinary incontinence in women. However, duloxetine is usually only prescribed by a specialist as a second-choice treatment after surgery.
It's thought duloxetine increases serotonin and noradrenaline in the spinal cord . This helps contract the muscle that regulates urine flow from the urethra to the bladder.
In children who experience bedwetting (nocturnal enuresis), studies show a tricyclic antidepressant, such as imipramine , may be used. Similarly to duloxetine, this is only used if other treatments have been unsatisfactory .
Imipramine may help with bedwetting as it relaxes the bladder muscle so children are less likely to release urine.
3. Eating disorders
Bulimia is an eating disorder characterised by purging (for example, making themselves vomit) and binge eating. As it's a complex mental health disorder, the first-choice treatment is psychotherapy . But fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is the only antidepressant licensed for bulimia. It's normally prescribed alongside psychotherapy if psychotherapy by itself hasn't worked.
A small study showed that fluoxetine was more effective than a placebo in treating some bulimia symptoms. It's unclear what the exact mechanism is, but some research suggests fluoxetine reduces depressive symptoms which may be associated with bulimia in some patients - making it easier for them to engage in psychotherapy.
4. OCD, panic and anxiety disorders
Antidepressants may also be useful for treating other mental health conditions - including obsessive-compulsive disorder (OCD), panic disorder and generalised anxiety disorder.
Research has shown SSRIs, such as fluoxetine and sertraline, may improve OCD symptoms in some patients. Both SSRIs and SNRIs have proven to be effective in managing symptoms of panic and generalised anxiety disorders .
The exact mechanism that enables antidepressants to work for these conditions is unknown. But it may be due to the increase in serotonin levels or changes in brain pathways which regulate mood, anxiety and compulsions.
5. Menopause
Although antidepressants are not licensed for this condition, they are sometimes used to treat menopausal symptoms.
Several studies show the SSRIs paroxetine and citalopram and the SNRI venlafaxine can help women. In particular, they reduce the frequency and severity of hot flushes - one of the most common menopause symptoms women seek help for. One review found that hot flushes can be reduced by up to 65% when using these antidepressants.
In menopause, a woman's oestrogen level drops. This is a hormone that stimulates the production of serotonin . But some studies suggest the lower levels of serotonin may be linked to hot flushes. This may explain why antidepressants are useful in managing hot flushes as they are thought to increase serotonin levels in the brain.
Hormone replacement therapy (HRT) is the most effective option for managing menopause symptoms such as hot flushes. But antidepressants may be useful for women who are unable to use HRT. But as there is limited research on using antidepressants to manage menopause symptoms, more studies will be needed.
For many of these conditions, antidepressants are the last treatment option. But for some, such as those with nerve pain, antidepressants are the most effective options. Antidepressants may not work for everyone - and they may cause side-effects in some people. This is why it's important to talk with your pharmacist or doctor if you have questions about taking an antidepressant you've been prescribed.
Dipa Kamdar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
