So let's talk a little bit about other drugs that
are used to manage pain. Anti-depressants
are widely used and have been used for years.
But they're used not because of their
primary effect on depression, but because
they increase norepinephrine
and serotonin activity in the spinal
cord. And they seem to reduce
response to pain, and then in addition, they often
activate the depressed chronic pain patient.
So patients who have chronic pain, very commonly
are depressed. These drugs seem to be
particularly effective for diabetic
neuropathy and postherpetic neuralgia.
And are often used in the treatment of those two disorders.
The two commonest ones are Amitriptyline
and Nortriptyline, but there's also Imipramine,
there's a whole series of these things. So the newer
antidepressant drugs, the Serotonin reuptake
inhibitors such as Paxil or paroxetine,
and even newer drugs, the Serotonin-norepinephrine
reuptake inhibitors such as duloxetine, have also
been used to treat peripheral neuropathy and seem
to have a positive effect. And then in addition, they also
have their antidepressant effect, which can be useful in these
patients. So another group of drugs that have been used