Serotonin is a neurotransmitter that regulates sleep patterns, mood, a feeling of well-being, and inhibition of pain. Since those with FM experience abnormal pain, it has been hypothesized that the pathophysiology underlying FM may be an impairment of serotonin metabolism. This hypothesis is supported by finding decreased serotonin metabolites in FM patient plasma and cerebrospinal fluid. However, medications such as selective serotonin reuptake inhibitors (SSRIs, a type of antidepressant that acts on serotonin levels such as Zoloft and Prozac) do not seem to alleviate the majority of FM pain, whereas drugs such as mixed serotonin norepinephrine reuptake inhibitors (SNRIs, a type of antidepressant that acts on both serotonin and norepinephrine levels) seem to be more successful. Examples of SNRIs include the drugs Cymbalta (duloxetine) and Savella (milnacipran) that also have been used to treat depression and the pain of diabetic neuropathy with some success.
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