Antipsychotics for fibromyalgia in adults

Area of Science:

• Pharmacology and Therapeutics
• Rheumatology and Pain Management
• Psychiatry and Mental Health

Background:

• Fibromyalgia is a chronic condition affecting 2% of the population, characterized by widespread pain, fatigue, and sleep disturbances.
• A significant comorbidity exists between fibromyalgia and depressive or anxiety disorders, impacting quality of life and disability.
• Current drug therapies aim to alleviate symptoms, reduce disability, and improve the quality of life for fibromyalgia patients.

Purpose of the Study:

• To evaluate the efficacy, tolerability, and safety of antipsychotic medications in adult fibromyalgia patients.
• To synthesize evidence from controlled trials assessing antipsychotics for fibromyalgia symptom management.

Main Methods:

• Systematic review of controlled trials of antipsychotics for fibromyalgia, with a minimum duration of four weeks.
• Searches conducted across CENTRAL, MEDLINE, EMBASE, reference lists, and clinical trial registries up to May 2016.
• Data extraction and risk of bias assessment performed independently by two reviewers, with evidence graded using the GRADE approach.

Main Results:

• Four studies with 296 participants were included, primarily evaluating quetiapine (an atypical antipsychotic) against placebo.
• Quetiapine did not demonstrate superiority over placebo for significant pain reduction (50% or greater), but showed benefits for 30% pain reduction, improved quality of life, sleep, depression, and anxiety.
• Quetiapine use was associated with statistically significant weight gain, while no significant differences were observed in tolerability, serious adverse events, or common side effects like dizziness and somnolence compared to placebo. Comparison with amitriptyline showed no significant differences in efficacy but higher adverse event withdrawal.

Conclusions:

• Very low-quality evidence suggests quetiapine may be considered for a short-term trial (4-12 weeks) in fibromyalgia patients with major depression to manage pain, sleep issues, depression, and anxiety.
• The potential benefits of quetiapine must be weighed against side effects, particularly weight gain, through shared decision-making with patients.
• No relevant studies on other antipsychotics for fibromyalgia were identified.