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The use of oral antidepressants is a valuable option in patients with chronic pruritus who are not responding to conventional therapy, especially patients with chronic kidney disease, cholestasis, and malignancies, according to the results of a recent systematic review conducted in The Netherlands and published in the Journal of the American Academy of Dermatology.
The investigators conducted a systematic literature search on the efficacy of antidepressants in patients with chronic pruritus, in which studies that provided original data were included.
A total of 35 studies that assessed the oral administration of selective serotonin reuptake inhibitors (fluoxetine, fluvoxamine, paroxetine, and sertraline), tricyclic antidepressants (amitriptyline, nortriptyline, and doxepin), and atypical antidepressants (mirtazapine) were included in the analysis.
Oral antidepressants are thought to have an antipruritic effect because of their influence on serotonin and histamine levels. A marked improvement in pruritus during treatment with oral antidepressants was reported in a majority of the articles reviewed, demonstrating evidence-based support for the use of these agents in patients with chronic pruritus.
The investigators concluded that more specific evidence-based treatment guidelines for various etiologies of pruritus is needed, since the literature comparing the efficacy of various systemic agents for the treatment of chronic pruritus is limited, based mainly on open-label trials, case series, and case reports.. In addition, more data are needed to compare the efficacy of oral antidepressants with that of other systematic agents.
Reference
Kouwenhoven TA, van de Kerkhof PCM, Kamsteeg M. Use of oral antidepressants in patients with chronic pruritus: a systematic review. J Am Acad Dermatol. 2017;77(6):1068-1073.
