Polio Place

Post-Polio Health, Volume 26, Number 2, Spring 2010
Ask Dr. Maynard
Frederick M. Maynard, MD

Question: Has there ever been a study of whether antidepressants help relieve muscular pain and fatigue? Is it a plausible treatment for people who have had polio?

Answer: There have been studies showing reduction of fatigue and pain (not specifically muscular pain) among depressed patients treated with antidepressant medications, but none considered pain as a "primary treatment outcome." Depressed mood was always the primary goal of treatment. Fatigue, pain, poor sleep, headache and other bodily symptoms are usually considered to be manifestations of the primary abnormal condition – depression.

I am not aware of any studies which specifically treated post-polio patients with antidepressant medication. I do know many physicians (including me) who have treated post-polio patients with antidepressant medications primarily for the purpose of helping them better cope with disabling pain and/or fatigue. Particularly when poor sleep and a general sense of hopelessness/despair about their condition are present, even if they don't "feel depressed" themselves, a careful trial of treatment with an antidepressant medication can be worthwhile.

It is always best that these patients be evaluated and possibly treated by a clinical psychologist or other mental health professional, either in combination with medication or as an alternative. Access to and cost of counseling are common barriers to this approach, as is the attitude of the patient toward mental health treatment. Support from family, friends, post-polio peer groups and spiritual counselors can also be helpful. I have had several patients experience resolution of their PPS symptoms with this holistic approach, which usually also involves lifestyle changes.