My Experience with Tricyclic Antidepressants for Pain Management

Like many of us, I’ve been forced to learn as much as I can about rheumatoid arthritis in the years since my diagnosis. As a bit of a researcher, I’ve learned about medications, alternative therapies, dietary treatments, and so much about the disease and how it often progresses. One of the first things I learned from my doctor is the role tricyclic antidepressants play in managing rheumatoid arthritis (RA/RD) pain.

A surprising prescription

Shortly after my diagnosis, my rheumatologist prescribed a tricyclic antidepressant. I gave her a bit of a quizzical look. I clearly recalled that I didn't mention anything to her about depression, anxiety, or mental health issues.

Is my pain even real?

At the time of my diagnosis, I absolutely did not want to take anything beyond what I strictly had to take. And honestly, especially after a long and difficult time leading to my diagnosis, I was concerned that my doctor was prescribing the antidepressant because she believed my pain and fatigue were related to my mental health rather than because of my actual rheumatoid arthritis.

In other words, I feared that she didn’t believe that my pain was, in fact, real. Moreover, I was concerned that she just assumed that I must be depressed now that I had a life-long incurable disease. Not to mention that I didn’t want to take any more medicine than I absolutely had to.

Physical pain and mental health

I believe many of us can relate to this concern. Unfortunately, it is very normal to struggle with having others understand and accept our pain and fatigue as “real,” especially in the traditional medical community. So, like me, you may be surprised and upset that your doctor would prescribe a medication traditionally used for mental health purposes.

How can antidepressants help with RA pain management?

Simply put, some tricyclic antidepressants have certain anti-inflammatory and pain-relieving properties.¹ It wasn’t until I had a frank conversation with my doctor about my concerns that she explained why she was prescribing this particular tricyclic antidepressant. This is something I would certainly encourage you to do, especially if you don’t fully understand or know why a particular medication might be prescribed by your doctors. I find it very valuable to understand the purpose of each medication, therapy, or treatment.

My experience with tricyclic antidepressants

For me, this prescription has been a life-saver in so many ways. Now, a few years down the road past my initial diagnosis and original prescription, I am very grateful for the ways it has helped me manage my physical pain. In addition, despite having no history of mental health challenges, like many of us with rheumatoid arthritis, I’ve faced some tough challenges with anxiety and depression.

Always talk to your doctor about what’s best for you

I want to be clear. I’m not saying that a tricyclic antidepressant is right for you. That can only be determined by you and your doctor. Rather, I’m trying to say that if your rheumatologist does speak to you about it, it isn’t necessarily because he/she doesn’t believe that your pain is real. Rather, it is quite common to take advantage of the pain-relieving properties of certain tricyclic antidepressants to help manage rheumatoid arthritis pain, even if you don’t consider the possibility of mental health complications when you have RA/RD.