What Is the Best Antidepressant for Nerve Pain?

Nerve pain, also called neuropathic pain or neuropathy, can significantly impact your quality of life and interfere with your daily activities. This type of pain is more likely to happen if there is damage to the nervous system or if the nervous system misfires. Many conditions can cause nerve pain, such as diabetes or spinal cord injuries. Antidepressants are a standard treatment for nerve pain. What is the best antidepressant for nerve pain? This article will discuss some of the options and help guide you as you work with your healthcare team to decide which option may be best for you.

List of antidepressants for neuropathy

When it comes to antidepressants for neuropathy, there are several options.

Drug	Drug Class	Common Dosage (Adults)	WellRx Savings Card
Amitriptyline	TCA	10-300 mg daily	WellRx Savings Card
Nortriptyline	TCA	25-50 mg 3-4 times daily	WellRx Savings Card
Duloxetine	SNRI	20-120 mg daily	WellRx Savings Card
Venlafaxine	SNRI	75-225 mg daily	WellRx Savings Card
Doxepin	TCA	75-150 mg daily	WellRx Savings Card
Imipramine	TCA	25-350 mg daily	WellRx Savings Card
Citalopram	SSRI	10-40 mg daily	WellRx Savings Card
Paroxetine	SSRI	10-50 mg daily	WellRx Savings Card
Fluoxetine	SSRI	10-60 mg daily	WellRx Savings Card
Bupropion	Atypical antidepressant	75-150 mg twice daily	WellRx Savings Card
Milnacipran	SNRI	50-100 mg twice daily	WellRx Savings Card

Many antidepressants are used off-label for chronic pain, which means that they are not explicitly approved by the Food and Drug Administration (FDA) for this specific indication.

When to use antidepressants for nerve pain

When it comes to nerve pain, you have many options for treatment. Healthcare providers often use antidepressants for nerve pain instead of medications such as opioids because they have less potential for dependence than opioid medications. If over-the-counter medications aren’t working, your healthcare provider may consider an antidepressant. Antidepressants are often the first choice for nerve pain if you also have depression or anxiety. Chronic pain conditions are frequently accompanied by depression and anxiety. Even people without depression commonly use antidepressants for neuropathy.

Types of drugs for neuropathic pain

There are several types of antidepressants for nerve pain relief.

Tricyclic antidepressants (TCAs)

One of the more common choices for treating neuropathy is to use tricyclic antidepressants for neuropathic pain. TCAs were first used for diabetic neuropathy in the 1970s. Since then, they’ve been shown to be effective in treating nerve pain, often at lower doses than those used for depression. Even though they are effective for treating nerve pain, it is becoming less common for healthcare providers to recommend tricyclic antidepressants for nerve pain due to the potential side effects:

• Sedation
• Dry mouth
• Blurry vision
• Urinary retention
• Dizziness
• Constipation

An advantage of TCAs for nerve pain, besides evidence that they are effective, is that they are often inexpensive. This makes them an appealing option for individuals without insurance or those with a fixed budget.

Selective serotonin reuptake inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are another class of antidepressants for nerve pain relief. Studies into the effectiveness of SSRIs for nerve pain have been inconclusive, though there does seem to be some benefit. SSRIs aren’t generally as effective as TCAs but have a better side effect profile. They are often used with TCAs to improve the overall pain control. Some of the potential side effects of SSRIs include:

• Nausea
• Vomiting
• Weight gain
• Diarrhea
• Headache
• Difficulty sleeping
• Sexual dysfunction

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs) are becoming more frequently used for nerve pain. These medications may also help in non-nerve pain conditions such as arthritis or chronic back pain. SNRIs are often better tolerated than SSRIs and TCAs. They also have more data showing their efficacy than SSRIs. These medications are not without potential side effects. Some of these include:

• Nausea
• Vomiting
• Diarrhea
• Dry mouth
• Headache
• Dizziness
• Difficulty sleeping

Duloxetine is the only antidepressant that the FDA approves explicitly for neuropathic pain.

Atypical antidepressants

Wellbutrin/bupropion is the most common atypical antidepressant for chronic pain. Bupropion is thought to work on the norepinephrine-dopamine reuptake system. One study found that 73% of people on bupropion reported improvement in their pain after 6 weeks. Some potential side effects of bupropion include:

• Difficulty sleeping
• Dizziness
• Dry mouth
• Decreased appetite
• Nausea
• Tremors
• Constipation

Is any antidepressant for nerve pain available over the counter?

There are many over-the-counter medications for nerve pain. However, in the United States, antidepressants are only available by prescription. Over-the-counter medications for nerve pain may include topical treatments such as lidocaine or capsaicin, or oral options like acetaminophen or ibuprofen.

How soon do antidepressants for nerve pain relief usually start working?

Antidepressants for nerve pain start working at different times. Amitriptyline may begin to work as soon as one to two weeks, but may take up to four to six weeks to reach maximum effect. Duloxetine may start to work as quickly as two to four weeks, but it may take up to 6 weeks to improve pain levels. Your healthcare provider will discuss when you should follow up to discuss adjusting the dose of your medication.

How to take antidepressants for neuropathic pain

Most antidepressants for neuropathic pain are taken once or twice daily, though some tricyclic antidepressants for nerve pain are dosed more often. As with any medication, you should take antidepressants as directed by your healthcare provider. If the medication causes drowsiness, consider taking it at night. If the medication keeps you awake, it may be better to take it in the morning. Your healthcare provider or pharmacist can direct you on whether to take your medication with food or on an empty stomach.

Natural remedies for nerve pain relief

Several natural remedies may help alleviate nerve pain. A 2018 review of medicinal herbs for neuropathic pain found several compounds [JF1] with potential benefit:

• Aconitum
• Citrullus colocynthis
• Goshajinkigan
• A. calmus
• A. scholaris
• Artemisia
• B. monosperma
• C. longa
• C. sativus
• E. angustifolia
• Ginkgo biloba
• M. speciosa
• M. charantia
• N. sativa
• O. sanctum
• P. amarus
• R. officinalis
• R. cordifolia
• S. officinalis

Capsaicin is a pepper derivative available over the counter that may help treat inflammation and pain by increasing blood flow to the affected area.

How to prevent nerve pain

Neuropathic pain is most commonly caused by conditions that damage the nerves. It can’t always be prevented, but there are a few steps that you can take to reduce your risk of developing this condition.

• Quit smoking
• Exercise regularly
• Eat a healthy diet
• Limit your alcohol intake
• Control your blood sugars

People with diabetes should also closely monitor their feet for signs of injury because diabetes is a risk factor for developing neuropathic pain.

Get your free ScriptSave® WellRx account and start saving on your medications

Medications are expensive, and their costs can vary significantly between pharmacies, even those located across the street. If you are experiencing nerve pain or if your healthcare provider has recommended medication, you may be wondering how to save money on your prescriptions. Consider visiting us at WellRx. Some people save a little. Some people save a lot. Prices vary across zip codes. Even pharmacies across the street from each other can have huge price differences. Our goal is to bring transparency to prescription medication pricing, enabling consumers to keep more money in their pockets. ScriptSave has been helping consumers save on their prescriptions for 25 years.

FAQs related to antidepressants for neuropathy

 

Can you take Wellbutrin for nerve pain?

Yes, Wellbutrin is an atypical antidepressant that is often used off-label to treat nerve pain.

Can you take venlafaxine for nerve pain?

Yes, venlafaxine is an SNRI that is often used off-label to treat nerve pain. The SNRI class has shown good efficacy for treating neuropathic pain.

Can you take Effexor for nerve pain?

Yes, Effexor is the brand name for venlafaxine and is often used off-label to treat nerve pain.

Can you take TCA for neuropathic pain?

Yes, you can take tricyclic antidepressants (TCAs) for nerve pain. These medications have been used off-label for nerve pain since the 1970s.

Can you take Lexapro for nerve pain?

Yes, you can take Lexapro to help manage nerve pain. However, Lexapro is an SSRI, which may be less effective than other antidepressants for nerve pain. While healthcare providers often use SSRIs for neuropathic pain, the studies show that they have less efficacy than the other antidepressant options for nerve pain.

Can you take bupropion for nerve pain?

Yes, bupropion is the generic name for Wellbutrin, which is an antidepressant sometimes used off-label to treat nerve pain.

What are the best alternatives to duloxetine for nerve pain?

Duloxetine is an SNRI and is the only antidepressant that is FDA-approved to treat pain. If duloxetine is not an option for you, TCAs and other SNRIs are often used to treat nerve pain. Alternatively, some anticonvulsants such as Lyrica (pregabalin) or gabapentin may be used to treat nerve pain.

What is the best SSRI for nerve pain?

SSRIs are sometimes used off-label for nerve pain; however, studies looking at the efficacy of these medications are mixed and suggest that SSRIs are less effective for nerve pain than some of the other antidepressants.

Which antidepressant is prescribed most often for nerve pain?

There are many antidepressants prescribed for nerve pain. However, duloxetine is the only antidepressant specifically approved by the FDA for nerve pain. Tricyclic antidepressants are also commonly used.

Is Lyrica an SSRI?

Lyrica (pregabalin) is an anticonvulsant not an SSRI. Lyrica is frequently prescribed for neuropathic pain.

How soon does Wellbutrin help with nerve pain?

Wellbutrin may start to work within a few weeks, but by the sixth week of treatment, around 73% of people reported improvement in their nerve pain in one study.

What is the best antidepressant to take with Lyrica?

Lyrica can be taken with several different antidepressants, including SSRIs and duloxetine. Your healthcare provider will work with you to determine which antidepressant is best for you.

What is the best alternative to Cymbalta for nerve pain?

Cymbalta is the generic name for duloxetine, which is the only antidepressant specifically indicated to treat nerve pain. TCAs, other SNRIs, or anticonvulsants are often prescribed as alternatives to Cymbalta for nerve pain, though other medications may be used.

What are the best tricyclic antidepressants for nerve pain?

There are several tricyclic antidepressants used for neuropathic pain. Studies have shown amitriptyline and desipramine to be effective for treating neuropathic pain. The best tricyclic antidepressant for nerve pain is the one that improves your symptoms with the fewest side effects.

 

References

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