These medications are commonly used to help control the pain and insomnia related to fibromyalgia and Still's.  Research has shown that a combination of 1 tricyclic and 1 SSRI is more effective than either one alone.


Amitriptyline - Elavil 25mg-50mg PM
Cyclobenzaprine - Flexeril 10mg-30mg PM
Doxepin - Sinequan 25mg-75mg PM
Nortriptyline - Pamelor 10mg-50mg PM
Trazodone-Desyrel 25mg-50mg PM

Elavil (Amitriptyline) dose is typically 25 to 50 mg per night. Elavil is known for pain relieving effects and ability to help sleep. This medication should be taken early in the evening, or half-dose in the evening and the other half at bedtime to avoid morning hangover.

Flexeril (Cyclobenzaprine) dose is usually 10 to 30 mg per night. A tricyclic drug similar to Elavil with muscle relaxant qualities. May be taken along with Elavil to provide muscle relaxant relief. This medication usually reaches its maximum effect after one to two weeks of continuous use.

Sinequan (Doxepin) a typical dose is 25 to 75 mg. Also a tricyclic that functions in the body as an antihistamine. Available in tablet form as well as liquid.

Pamelor (Nortriptyline) the usual dose is 10 to 50 mg per night. Similar effects as Elavil but may be less sedating.

Desyrel (Trazodone) the usual dose is 25 mg to 50 mg per night. Desyrel is as effective as the other anti-depressants, however, is chemically different and may be less likely to cause side effects. Desyrel is a mild stimulant and may make a sleep problem worse if combined with a tricyclic anti-depressant at night.

Many of the tricyclic anti-depressants have side effects that may be intolerable for some people. These include constipation, drowsiness, dry mouth and eyes, headache, heart rate abnormalities, increased sensitivity to sunlight, morning "hangover," and weight gain. These side effects may improve after patients have been using the medication for a few weeks. If not, the doctor should be consulted regarding another medication.


Fluoxetine - Prozac 1mg-20mg AM
Paroxetine - Paxil 5mg-20mg AM
Sertraline - Zoloft 50mg-200mg AM
Nefazodone-Serzone 100mg-150mg AM+PM
Venlafaxine-Effexor 37.5mg-150mg AM

Prozac (Fluoxetine) is available in liquid as well as tablet form. Typical dose is 1 to 20 mg in the morning. Prozac may cause insomnia, but it can be taken in combination with one of the sedating tricyclics such as Elavil or Sinequan.

Paxil (Paroxetine hydrochloride) the usual dose is 5 to 20 mg in the morning.. This medication is the most potent of this type. A sedating medication may be needed at night in conjunction with Paxil. It can cause nervousness, insomnia, nausea, sexual difficulties and sweating, although many patients report having fewer side effects with Paxil as compared to Prozac.

Zoloft (Sertraline) 50 to 200 mg is the usual dosage. Anecdotally proven helpful for some patients. Sedating medication may also be needed to combat insomnia.

Serzone (Nefazodone) is the newest of these agents. As well as increasing serotonin, it also increases norespinephrine. Serzone's efficacy and side effects are similar to Effexor.

Effexor (venlafaxine hydrochloride) the usual dose is 27.5 mg two times per day. This dosage can be adjusted, depending on the effects. Effexor is not related to the tricyclics or the Prozac-like drugs, however, it does boost serotonin and has tricyclic properties. The typical side effects are nervousness, anxiety, insomnia and increased blood pressure.

The following are some of the side effects of serotonin boosting medications: anxiety/nervousness, headache, insomnia, mood swings, sexual difficulties, nausea and stomach distress.

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