The purpose of this review is to present relatively detailed information on the characteristics of tricyclic antidepressants, mainly amitriptyline hydrochloride and doxepin
hydrochloride, for use as an integral part of the safe and effective management of fibromyalgia and, to a lesser extent, other chronic pain syndromes. Data sources include MEDLINE searches in English, relevant reference books and textbooks, my personal database and library, as well as personal clinical experience. I discuss these data with regard to the
pharmacologic characteristics, mechanisms of action, adverse effects, and precautions involved with
the use of tricyclic antidepressants. Additional information is given on drug selection and dosage
titration. Much emphasis is placed on the fact that while tricyclic antidepressants play a major role
in the management of fibromyalgia and other chronic pain syndromes, lifestyle alterations (eg, physical reconditioning and exercise), as well as behavior modification, are also vital to a successful
outcome in management.
(Arch Intern Med. 1996; 156:1047-1052)