A comparative trial of amitriptyline and zimelidine in post-herpetic neuralgia

Serotoninergic pathways are believed to be important in pain mechanisms. Accordingly, we studied the action of zimelidine, a very highly serotoninergic antidepressant, in relieving the pain of post-herpetic neuralgia. Fifteen patients received zimelidine and amitriptyline in that order in an open-label cross-over study. Only one patient with zimelidine obtained a good result, whereas 8 patients on amitriptyline had a good result or better (P < 0.02). We conclude that amitriptyline has a pain-relieving action, at least in post-herpetic neuralgia, which is not primarily linked with its serotoninergic effects and which is also independent of its effects on depression.