Which antidepressants are best for treating chronic pain?

Readers in Garfield ask which antidepressant is "best" for chronic pain, and a short list of drug names is easy to mistake for an answer.

Is there a best one

We do not name a best antidepressant for chronic pain. Antidepressants do appear in pain care, though. Healthline lists adjuvant analgesics, such as antidepressants and anticonvulsants, among the medications used for chronic pain.

Which drug names appear

Cleveland Clinic's migraine headaches page lists tricyclic antidepressants, naming amitriptyline, nortriptyline and doxepin. Those are names listed for one condition, not a ranking, and they do not settle which one suits back pain or any other kind.

Which drug fits depends on your history, your other medications and your clinician's judgment, none of which a general page can see. A claim that one drug is best for everyone is a reason for skepticism.

Questions to take to the appointment

Ask why this drug was chosen for your pain, what it is expected to change, how long it should be tried before you judge it, and what it costs per month. Cost is where a ballpark and a quote part ways, so ask for the pharmacy price of the exact drug and dose instead of a general range. For background reading, MedlinePlus on chronic pain, NCCIH's page on complementary health approaches and Healthline's overview of what causes chronic pain give general context.

Choosing a medication with your clinician

"Best" is a question about a person, not a drug. Do not start, stop or change a medication based on a web page. Pricing notes like these are not medical advice.