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Citalopram Shows Promise in Treating Symptoms of Fibromyalgia: Presented at AAPM

By Jill Stein
Special to DG News

NEW ORLEANS, LA -- February 21, 2003 -- The antidepressant citalopram helps improve pain, fibromyalgia symptoms, sleep, and tender points in patients with primary idiopathic fibromyalgia, investigators reported on February 20^th at the 19^th Annual Meeting of the American Academy of Pain Medicine.

Dr. William G. Kee and colleagues at the Medical University of South Carolina in Charleston, United States, evaluated the use of citalopram in 22 patients with fibromyalgia.

Depression was evaluated at baseline using the Beck Depression Inventory II. Eleven patients had minimal depression (score <14), and 11 had moderate to severe depression (score 19 or higher).

Following a 1-week washout from all medications for pain, sleep or depression, patients were treated with citalopram 20 mg/day to 40 mg/day for six weeks. They were not permitted to take their usual analgesic medications and instead were provided with hydrocodone 5 mg/acetaminophen 500 mg twice daily as a rescue medication.

Evaluation at the end of the trial showed significant (p=0.01 to p=0.05) improvement in scores on the Visual Analogue Scale, McGill Pain Questionnaire, Fibromyalgia Impact Questionnaire, sleep, four tender points, two control points, and the pooled tender point score.

Results show that both depressed and non-depressed patients had significant improvement on all measures. A maximum of 42% of the change in pain was attributable to changes in depression, leaving 58% attributable to other factors, Dr. Kee said.

Changes in the objective measure of tender point and control point thresholds seen with citalopram in the present trial have not been shown in prior studies, he added.

He also observed that the decreases in threshold sensitivity at classic tender points as well as control points indicate that central sensitivity is a factor in the symptoms of fibromyalgia.

While earlier studies examined the use of citalopram for the treatment of fibromyalgia, their results were inconclusive because of problems in trial design, Dr. Kee noted.

The present investigation improves on prior work by including only patients with idiopathic fibromyalgia and controlling patient use of analgesic medications during the study, he said. This trial also screened patients for depression with two measures and made "a clear separation" between depressed and non-depressed patients.

Overall, the results demonstrate that citalopram is effective in making changes in the symptoms of fibromyalgia beyond changes seen in mood, Dr. Kee concluded.

The study was supported by Forest Laboratories.


[Study title: Citalopram in the Treatment of Fibromyalgia]

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