Ask the Doctors March 2014 Issue

Ask The Doctors: March 2014

The best time to take medications...................Can antidepressants help arthritis pain?..........................

Q. I take several medications to treat both my osteoarthritis and high cholesterol. Some of the medication directions say to to take the drug first thing in the morning, while others should be taken in the evening or right before going to bed. Does it really make a difference when I take the medications?

A. Even though most instructions on a pill bottle simply say to take the medication “once a day,” the specific time of day it’s taken may make an important difference. Because your body does not respond to medications in the same way at different times of the day, some drugs are not as effective or as well tolerated if they’re taken at the wrong time.
While drugs taken at the wrong time may not be completely ineffective, they may be less effective. Research has shown that drugs labeled “take one a day” often work better when taken at night. For instance, statins should be taken at bedtime, according to a study published in the British Medical Journal (Oct. 2003). The research shows that cholesterol production in the liver is highest after midnight and lowest during the morning and early afternoon, making statins most effective when taken just before bedtime.
When taking nonsteroidal anti-inflammatory drugs (NSAIDs) it’s best to take them four to six hours before the pain is at its worst, according to French research published in Clinical Pharmacology and Therapeutics (1985). For instance, taking an NSAID around mid-morning to noon will alleviate afternoon pain. To address nighttime pain, take them with your evening meal. If taking an NSAID twice daily, it should be scheduled eight to 12 hours apart. If needed four times a day, an NSAID can be taken every six hours. Both prescription and over-the-counter NSAIDs are best taken with a meal to prevent gastrointestinal problems, including stomach upset and ulcers.

Q. I have been in chronic pain from osteoarthritis throughout my body for many years, which has led to a diagnosis of depression. My doctor has recommended that it may be time for me to start taking an antidepressant to help with my overall health. How how would this benefit me?

A. It’s not uncommon for patients with chronic pain, such as arthritis, to be prescribed antidepressants. Some of the more common antidepressants include drugs referred to as selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac®), escitalopram (Lexapro®) and paroxetine (Paxil®), which are beneficial due to their ability to target the neurotransmitter (brain chemical) serotonin.

A separate class of antidepressants is called SNRIs (selective serotonin-norepinephrine reuptake inhibitors)—also referred to as dual inhibitors or dual reuptake inhibitors. Common SNRIs include duloxetine hydrochloride (Cymbalta®) and venlafaxine (Effexor®). Both classes of antidepressants (SSRIs and dual inhibitors) have been shown to control fatigue and pain associated with fibromyalgia or chronic pain syndromes, including arthritis, although dual inhibitors may be more effective in terms of pain relief.

Recently, the U.S. Food and Drug Administration (FDA) approved duloxetine hydrochloride to treat chronic musculoskeletal pain, including discomfort from OA and chronic lower back pain.

Before beginning an antidepressant, make certain to discuss all of the benefits and potential side effects of taking the medication with your doctor. The FDA states that adults should be observed for increased depression or suicidal thoughts during the first few months of treatment or following a change in medication dosage. Patients should contact their doctor immediately if their depression symptoms worsen or if suicidal thoughts or behavior increase when taking an antidepressant.