Treatment of functional chest pain with antidepressants: A meta-analysis

Background: Recurrent Functional Chest pain (FCP) with normal coronary anatomy and no detectable gastroenterological and respiratory causes is a common problem that sometimes leads to excess use of medical care. Objective: The purpose of this meta-analysis is to investigate the efficacy of antidepressant treatments for FCP. Settings: MEDLINE, PsycINFO, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to July 2011. Randomized controlled trials (RCTs) that tested any type of antidepressants for FCP with normal coronary anatomy were analyzed. Diagnoses included non-specific chest pain, noncardiac chest pain, atypical chest pain, syndrome X, or chest pain with normal coronary anatomy. Methods: Two authors independently extracted data. Effects were summarized using standardized mean differences (SMDs), weighed mean differences (WMD), or odds ratio (OR) by suitable effects model. Results: Seven RCTs (median duration, 5 weeks; range, 3 - 16 weeks) involving 319 participants were included. There was strong evidence for an association of antidepressants with reduction in pain (SMD -1.26; 95% confidence interval [CI], -2.34 to -0.19) and psychological symptoms (SMD -0.87; 95% CI, -1.67 to - 0.08) as well as increased side effects (OR 0.34; 95% CI, 0.15 to 0.78). Current analysis did not support the association of antidepressants with improved health related quality of life (WMD 2.00; 95% CI, - 2.54 to - 6.65). Limitations: Demographics, co-morbidities of study participants and the amount of comedication were not reported, these possible sources of heterogeneity could not be examined. Conclusions: Antidepressant medications are associated with improvements in pain and psychological symptoms. The effects of factors including psychiatric co-morbidity, gender, age, ethnic group, and treating period on the outcomes should be checked further.