Original article
Use of oral antidepressants in patients with chronic pruritus: A systematic review

https://doi.org/10.1016/j.jaad.2017.08.025Get rights and content

Background

Chronic pruritus is a common skin symptom with marked impact on quality of life. Adequate treatment can be challenging for clinicians, demanding the exploration of new treatment options such as oral antidepressants.

Objective

To evaluate the use of oral antidepressants in chronic pruritus by a systematic overview of the available relevant literature.

Methods

The PubMed, EMBASE, Cochrane, and Web of Science databases were searched. Studies providing original data on the efficacy of oral antidepressants in patients with chronic pruritus were included. We assessed the risk for bias by using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies.

Results

A total of 35 studies evaluating the oral use of fluoxetine, fluvoxamine, paroxetine, sertraline, amitriptyline, nortriptyline, doxepin, and mirtazapine were included. The majority of included articles showed a marked improvement of pruritus during treatment with oral antidepressants.

Limitations

Recommendations are mainly based on open-label trials, case series, and case reports.

Conclusion

Oral antidepressants should be considered in patients with chronic pruritus that is unresponsive to topical treatment and oral antihistamines, particularly in patients with uremic pruritus, cholestatic pruritus, or paraneoplastic pruritus. More evidence based on randomized-controlled trials is required.

Section snippets

Methods

We conducted a systematic literature search on the efficacy of antidepressants in patients with chronic pruritus. Four electronic databases (PubMed, EMBASE, Cochrane, and Web of Science) were systematically searched for articles published from January 1980 to December 2016. The search terms were itch, pruritus, and antidepressants, with all possible synonyms and generic names included. An extensive overview of the search terms is available upon request from the corresponding author. Methods for

Results

A total of 35 studies evaluating the use of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and/or atypical antidepressants (Supplemental Table II; available at http://www.jaad.org) fulfilled the criteria of this study.9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40 One article evaluated the use of oral antidepressants in general, analyzing treatment outcomes in 385 patients with

Discussion

The majority of included studies showed an improvement of pruritus after initiation of oral antidepressants, indicating that treatment with oral antidepressants is a useful additional option for treatment of chronic pruritus. Most evidence was found for chronic pruritus due to malignancies, cholestasis, and chronic kidney disease. Pruritus due to malignant disease often requires symptomatic treatment.13 Paroxetine, 20 to 30 mg/d, or mirtazapine, 10 to 20 mg/d, are both effective therapeutic

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    Funding sources: None.

    Conflicts of interest: None declared.

    Reprints not available from the authors.

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    © 2017 by the American Academy of Dermatology, Inc.