Clinical Question

Are antidepressants safe and effective for the treatment of hip and knee osteoarthritis (OA)?

Evidence-Based Answer

Antidepressants provide a 50% or greater pain reduction in patients with hip and knee OA compared with placebo (number needed to treat [NNT] = 6; 95% CI, 4 to 11). (Strength of Recommendation [SOR]: A, consistent, good-quality patient-oriented evidence.) Antidepressants cause more adverse effects (number needed to harm [NNH] = 7; 95% CI, 5 to 11) compared with placebo.¹ (SOR: A, consistent, good-quality patient-oriented evidence.)

Practice Pointers

The estimated worldwide prevalence of OA of the hips and knees is 0.85% and 3.8%, respectively.² OA can lead to pain that affects physical and social function and mood, and it can be a financial burden. Although nonsteroidal anti-inflammatory drugs and intra-articular injection combined with nonpharmacologic interventions (e.g., structured exercise, weight loss) are commonly used to relieve pain, most patients are not satisfied with their pain control.^3,4 Antidepressants may inhibit sensory transmission in nociceptive fibers of the spinal cord through serotonin and norepinephrine reuptake inhibition.⁵ The authors of the review sought to determine if antidepressants improve outcomes in people with hip or knee OA compared with placebo.