Tricyclic antidepressant use in diabetic neuropathy

OBJECTIVE: To determine whether all tricyclic antidepressants are equally effective in the treatment of painful diabetic neuropathy. DATA SOURCES: A MEDLINE search for randomized controlled studies was conducted from January 1966 to December 1998. CONCLUSIONS: Amitriptyline, imipramine, and desipramine are superior to placebo in relieving painful diabetic neuropathy. Desipramine has been shown in one small study to have efficacy equal to amitriptyline. Imipramine has been compared with amitriptyline in another small study, but the lack of statistics and adverse effect evaluation did not allow for critical comparison between the two agents. No randomized studies on nortriptyline monotherapy in diabetic neuropathy have been published. Data are insufficient to determine whether all tricyclic antidepressants are equally effective. Amitriptyline and desipramine are reasonable first choices in treating diabetic neuropathy.