The efficacy of antidepressants and antiepileptic drugs in the treatment of neuropathic pain is comparable; tolerability also is comparable, but safety and side effect profiles differ.Tricyclic antidepressants are the most cost-effective agents, but second-generation antiepileptic drugs are associated with fewer safety concerns in elderly patients.These drugs are a good choice for some people whose depression is resistant to other drugs.Although cyclic antidepressants can be effective, some people find their side effects difficult to tolerate.According to a recent survey1 of the most common reasons for patient visits to family physicians in the United States, depression and anxiety ranked 11th and 17th, respectively.Ten to 20 percent of adults in the United States experience depression at some point in their lifetime.2 Many antidepressants have been released in the United States over the past two decades.
Mirtazapine, which is unrelated to the selective serotonin reuptake inhibitors, is unique in its action—stimulating the release of norepinephrine and serotonin.
Extended-release venlafaxine has recently been approved by the U. Food and Drug Administration for the treatment of generalized anxiety disorder.
New indications for selective serotonin reuptake inhibitors include post-traumatic stress disorder, premenstrual dysphoric disorder, and generalized anxiety disorder.
Although sedatives do not relieve pain in themselves, they can be a useful adjunct to analgesics in preparing patients for surgery, and are commonly given to patients before they are anaesthetized, or before other highly uncomfortable and invasive procedures like cardiac catheterization, colonoscopy or MRI.
They increase tractability and compliance of children or troublesome or demanding patients.