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Supplements and Vitamins

June 5, 2000
Vitamins, Antidepressants May Help in Fibromyalgia

About 20 percent of patients referred to rheumatologists are diagnosed with fibromyalgia (FM), yet experts continue to debate the cause of this often-debilitating disease. Characterized by chronic musculoskeletal pain, chronic fatigue, sensitivity to light, sound, medications and allergens, this illness affects almost all the body's systems.

"There are no absolute abnormalities, no laboratory diagnosis that can confirm this diagnosis," explained Dr. Mohammad Hussain of Prince Albert, Saskatchewan, Canada, to an audience of his colleagues last week at the annual meeting of the American Psychiatric Association in Chicago.

One intriguing aspect of fibromyalgia (FM), said Hussain, is its connection to depression. While depression affects only about 12.5 percent of individuals before they develop FM, similar to its incidence in the general population, 76 percent of those who have the condition also suffer from depression.

"Therefore, depression is neither an underlying cause nor a predisposing factor for FM, but is a common manifestation of this syndrome. So there has to be a common triggering mechanism…" Hussain stated.

Many experts in this area suspect that FM has two distinct aspects, affecting both the immune system and mood, he explained. "We know that activities like sleep, fatigue and pain perception are altered when there is immune dysfunction. So some people believe there's coexisting mood disorder and immune disturbance.

"It has been seen that one-third [of FM patients] have a normal psychological profile, one-third have a profile [similar to that] of chronic pain sufferers, and one-third have serious psychological disturbances," Hussain stated. "It's also been related to preceding events in life, [such as] trauma".

He and his colleagues studied the effects of treating FM patients with a combination therapy that included both antidepressants and vitamin supplements. Seventy adult subjects -- 11 male and 59 female -- had weekly intravenous infusions of vitamin C, vitamin B complex and magnesium. Each also took daily antidepressants, mostly paroxetine (Paxil) and/or amoxapine. The patients completed symptom-rating scales at baseline and at one, two and four months into the study.

The 60 patients who continued to take the combination of vitamin infusions and oral antidepressants showed continual progress, with 45 reducing their symptom scores almost to the normal range. Nine patients stopped taking the antidepressants but continued the vitamin therapy – they made some progress, but their symptom scores stayed about twice as high as those who took both.

"The conclusion is that [combination] treatment with vitamin C, magnesium sulfate and antidepressants improves FM symptoms, energy and quality of life," stated Hussain. He explained that vitamin C is a component of connective tissue and is a powerful antioxidant, and that "magnesium is involved in over 300 chemical reactions in the body".

In the Saskatchewan study, the researchers and the patients knew exactly what treatment they were receiving, Hussain noted. Thus, the findings he presented need to be replicated and verified in a double-blind study where neither the patients nor the investigators know which patients are receiving the treatment and which are getting a placebo.

Editorial Commentary by Dr. Joshua Freedman: Fibromyalgia remains something of a mystery disease, and may actually consist of a number of different conditions. Partly due to lack of funding, there is relatively little rigorous research on either the syndrome or its treatment. Antidepressants are sometimes helpful, and always worth trying if depression symptoms are present.

© 2000 All rights reserved.

1: Am J Med 1998 Mar;104(3):227-31  

A randomized, double-blind, placebo-controlled study of growth hormone in the treatment of fibromyalgia.
Bennett RM, Clark SC, Walczyk J
Department of Medicine, Oregon Health Sciences University, Portland 97201, USA.
PURPOSE: The cause of fibromyalgia (FM) is not known. Low levels of insulin-like growth factor 1 (IGF-1), a surrogate marker for low growth hormone (GH) secretion, occur in about one third of patients who have many clinical features of growth hormone deficiency, such as diminished energy, dysphoria, impaired cognition, poor general health, reduced exercise capacity, muscle weakness, and cold intolerance. To determine whether suboptimal growth hormone production could be relevant to the symptomatology of fibromyalgia, we assessed the clinical effects of treatment with growth hormone. METHODS: Fifty women with fibromyalgia and low IGF-1 levels were enrolled in a randomized, placebo-controlled, double-blind study of 9 months' duration. They gave themselves daily subcutaneous injections of growth hormone or placebo. Two outcome measures--the Fibromyalgia Impact Questionnaire and the number of fibromyalgia tender points-were evaluated at 3-monthly intervals by a blinded investigator. An unblinded investigator reviewed the IGF-1 results monthly and adjusted the growth hormone dose to achieve an IGF-1 level of about 250 ng/mL. RESULTS: Daily growth hormone injections resulted in a prompt and sustained increase in IGF-1 levels. The treatment (n=22) group showed a significant improvement over the placebo group (n=23) at 9 months in both the Fibromyalgia Impact Questionnaire score (P <0.04) and the tender point score (P <0.03). Fifteen subjects in the growth hormone group and 6 subjects in the control group experienced a global improvement (P <0.02). There was a delayed response to therapy, with most patients experiencing improvement at the 6-month mark. After discontinuing growth hormone, patients experienced a worsening of symptoms. Carpal tunnel symptoms were more prevalent in the growth hormone group (7 versus 1); no other adverse events were more common in this group. CONCLUSIONS: Women with fibromyalgia and low IGF-1 levels experienced an improvement in their overall symptomatology and number of tender points after 9 months of daily growth hormone therapy. This suggests that a secondary growth hormone deficiency may be responsible for some of the symptoms of fibromyalgia.
Publication Types:
   Clinical trial
   Randomized controlled trial
PMID: 9552084, UI: 98211811