Antipsychotic Drugs for Fibromyalgia Treatment
Can Risperdal, Zyprexa, Seroquel and Other Neuroleptics Help FMS?
Dec 2, 2008
Antipsychotic drugs, also known as neuroleptics, are used in the treatment of schizophrenia and other psychotic conditions, sometimes also for bipolar disorder and even for depression and anxiety. Some of them are also used off-label for insomnia and chronic pain.
Many people are averse to the idea of taking antipsychotic medication, especially if they do not have a diagnosis of psychosis. It may seem like the doctor thinks they are crazy, and this can be true sometimes, but there are valid reasons for using neuroleptics to treat chronic illness, even if it isn't of psychiatric origin.
Both the older "typical" and the newer "atypical" antipsychotic drugs work by blocking dopamine receptors in the brain, as excess levels of dopamine are thought to cause the symptoms of psychosis, such as hallucinations and delusions. The atypical antipsychotic drugs (like Risperdal and Abilify) also block 5-HT2 serotonin receptors. Several atypical antipsychotic drugs have been used in fibromyalgia.
Most antipsychotic drugs, similar to tricyclic antidepressants are not very selective for these receptors and can also block e.g. histamine and acetylcholine receptors. As a result their effects and side effects can be very different.
Antipsychotic Drugs and Fibromyalgia
There are some theories that lack of dopamine may be involved in causing the symptoms of fibromyalgia. Thus it may seem strange that drugs that further reduce the action of dopamine would be used to treat FM, but in small doses some of these drugs can actually increase levels of dopamine and serotonin in the brain.
One problem with antipsychotic drugs is that they can cause significant side effects, such as sleepiness, tardive dyskinesia (involuntary movements) and weight gain, which can be severe. There is also a small risk for neuroleptic malignant syndrome, which is a medical emergency.
The doses of antipsychotic drugs used in the treatment of fibromyalgia are usually small and thus major side effects are not as likely as in the treatment of psychosis, but as there are hundreds of other, safer options (like anticonvulsants and NMDA antagonists), other treatments should probably be explored first.
Antipsychotic Drugs
The following antipsychotic drugs have been used to treat fibromyalgia:
Olanzapine (Zyprexa)
Olanzapine has been used to treat various conditions from PTSD to chronic headache. It blocks 5-HT3 serotonin receptors, a mode of action which is often very helpful in fibromyalgia. Several papers have been published about the use of Zyprexa in fibromyalgia. One concluded olanzapine helped 43% of study completers - but almost half of original participants dropped out because of the side effects. Olanzapine is particularly notorious in the weight gain department.
Risperidone (Risperdal)
Risperidone is sometimes used in low doses in the treatment of depression and anxiety. There are anecdotal reports of it being helpful in fibromyalgia. It is not as prone to causing weight gain as most other antipsychotic medications.
Quetiapine (Seroquel)
In many countries Seroquel is used off-label more than on-label, most often for sleep, as it is extremely sedative. In one study quetiapine proved helpful for fatigue and stiffness in fibromyalgia, but did not alleviate pain. Another fibromyalgia study combined quetiapine with pregabalin (Lyrica) with good results, though there were many drop-outs.
Amisulpride (Solian) and Sulpiride (Dolmatil)
Besides treatment of psychosis, amisulpride and sulpiride are both approved in some European countries for treating dysthymia (mild chronic depression). They can also relieve anxiety, vertigo and tinnitus. Some people find them sedative, but for many they have a stimulating effect, relieving fatigue. They are not available in the United States or Canada.
References
Haavisto Maija. Reviving the Broken Marionette: Treatments for CFS/ME and Fibromyalgia. 2008.
Wood PB, Schweinhardt P, Jaeger E, et al. Fibromyalgia patients show an abnormal dopamine response to pain. Eur J Neurosci. 2007 Jun;25(12):3576-82.
Rico-Villademoros F, Hidalgo J, Dominguez I, et al. Atypical antipsychotics in the treatment of fibromyalgia: a case series with olanzapine. Prog Neuropsychopharmacol Biol Psychiatry. 2005 Jan;29(1):161-4.
Hidalgo J, Rico-Villademoros F, Calandre EP. An open-label study of quetiapine in the treatment of fibromyalgia. Prog Neuropsychopharmacol Biol Psychiatry. 2007 Jan 30;31(1):71-7.
Calandre EP, Morillas-Arques P, Rodriguez-Lopez CM, et al. Pregabalin augmentation of quetiapine therapy in the treatment of fibromyalgia: an open-label, prospective trial. Pharmacopsychiatry. 2007 Mar;40(2):68-71.
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