Beyond Depression: The Role of Antidepressants in Managing Chronic Temporomandibular Disorders. A Systematic Review.

Abstract

Background: Chronic temporomandibular disorder (TMD) pain significantly impairs quality of life and lacks universally effective treatments. Antidepressants, traditionally used for mood disorders, have shown potential in managing chronic pain conditions. This systematic review evaluates the efficacy and safety of antidepressants for chronic TMD pain management.

Methods: Eligibility criteria: Included randomised controlled trials (RCTs) assessing antidepressants for chronic TMD pain in adults, reporting pain reduction or functional improvement as outcomes.

Information sources: Searches were conducted in MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Cochrane Library through April 2024. Risk of bias: The Cochrane Risk of Bias 2 tool was used to assess study quality.

Synthesis of results: Narrative synthesis was performed due to heterogeneity in interventions and outcomes.

Results: Included studies: Seven RCTs with sample sizes ranging from 12 to 80 participants. Studies evaluated various antidepressants, including amitriptyline, duloxetine, nortriptyline, and citalopram, alone or combined with non-pharmacological treatments.

Synthesis of results: Amitriptyline and duloxetine demonstrated significant reductions in pain intensity when used in combination therapies. Functional improvements, such as increased mouth opening, were observed in some studies. Side effects, particularly with duloxetine, were more frequent than with placebo. Variability in study designs, populations, and outcome measures limited comparability. Small sample sizes, short follow-up durations, and heterogeneity in interventions and outcomes reduced the strength of evidence.

Conclusion: Antidepressants, particularly when combined with non-pharmacological treatments, may enhance pain relief and functional outcomes for chronic TMD pain. However, high-quality, long-term studies are needed.