Care required when prescribing antidepressants for osteoarthritis pain

Based on moderate and high‐certainty evidence, although antidepressant use in lower-limb osteoarthritis improves pain, function and quality of life, the degree of improvement is small and not clinically important across the whole population.

However, also based on high‐certainty evidence, the proportion of people achieving a clinically meaningful improvement in pain is higher in people taking antidepressants. This suggests that there may be a subpopulation more likely to respond to this therapy.

Antidepressant use is associated with an increased number of adverse events compared with placebo and consequentially has reduced tolerability. Serious adverse events were present in all trials, but with no preponderance towards either the antidepressants or placebo. Adverse events may limit the use of antidepressants in the community, and patient comorbidities need to be considered.