Antidepressants are frequently prescribed to manage pain in older adults, but emerging research highlights that the evidence supporting this practice is surprisingly weak.
A recent study from the University of Sydney calls into question the widespread use of these medications for chronic pain in people over 65, urging healthcare professionals to reconsider their approach to treatment.
Over the past four decades, only 15 clinical trials have specifically explored the use of antidepressants for pain relief in older adults.
This new research, which synthesises data from these trials, found little evidence to justify the common practice of prescribing antidepressants to manage non-cancer pain in this age group.
Despite this lack of solid evidence, many international guidelines still recommend antidepressants for treating chronic pain conditions like osteoarthritis. These guidelines often fail to account for the unique needs of older adults, whose bodies process medications differently from younger patients.
This mismatch in treatment recommendations could potentially expose elderly individuals to unnecessary harm.
Dr Sujita Narayan, the study’s lead author from the University of Sydney’s Institute for Musculoskeletal Health, pointed out the problem with current clinical practice. “When time-poor clinicians consult guidelines for managing chronic pain, they may only focus on the key recommendations, many of which include the use of antidepressants.
Unfortunately, these guidelines often rely on studies that exclude or include very few older adults,” she explained.
The study’s findings highlight a concerning gap in understanding the risks of prescribing antidepressants to older patients for pain management. According to the research, many of these individuals experienced adverse side effects, including dizziness, falls, and even injuries.
The harm associated with these drugs frequently outweighed their potential benefits, leading to a higher rate of treatment discontinuation among patients compared to those given placebo or other pain medications.
In some cases, stopping antidepressant treatment can be as challenging as opioid withdrawal. Dr Narayan stressed the importance of consulting a clinician before discontinuing any medication, advising that patients devise a tapering plan if necessary, rather than stopping abruptly.
While the overall findings cast doubt on the efficacy of antidepressants for pain in older adults, there was one notable exception. The study found that duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), provided some relief for those suffering from knee osteoarthritis.
However, this benefit was limited to intermediate-term use (roughly two to four months). It did not offer immediate relief or long-term benefits, and no data was available to assess its effectiveness beyond a year.
For patients considering duloxetine for osteoarthritis, Dr Narayan cautioned that the relief may be minor and needs to be balanced against the risks associated with the drug.
Associate Professor Christina Abdel Shaheed, a co-author of the study from the University of Sydney’s School of Public Health, pointed out that no trials have specifically examined the use of antidepressants for acute pain, such as pain from shingles or muscular injuries.
She stressed the need to rethink current clinical practices and update guidelines to reflect the reality that antidepressants may not be as effective for pain relief in older adults as once thought.
Instead, the research supports a more holistic approach to managing chronic pain in older adults, incorporating non-pharmacological treatments such as physical exercise and cognitive behavioural therapy.
These methods have shown promise in trials conducted specifically on older people and offer a safer alternative to medications that may pose significant risks.
This new research from the University of Sydney highlights the need for clinicians to reconsider their reliance on antidepressants as a go-to solution for managing pain in older adults.
With limited evidence supporting their effectiveness and well-documented risks of harm, healthcare professionals are encouraged to explore more multidimensional treatment strategies tailored to the specific needs of older patients.
