Symptoms of Major Depression and Tricyclic Side Effects in Primary Care Patients

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 1997 May 1

PMID 9159697

Citations 7

Authors

B L Rollman

M R Block

H C Schulberg

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the prevalence and course of symptoms resembling side effects of tricyclic antidepressants among primary care patients experiencing major depression and receiving nortriptyline pharmacotherapy.

Design: Prospective cohort study.

Patients: Seventy-five patients meeting DSM-III-R criteria for a current major depression.

Setting: Four Pittsburgh (Pa.) ambulatory health centers affiliated with residency programs.

Measurements And Main Results: Symptoms resembling tricyclic side effects were assessed at baseline and at monthly intervals using the Somatic Symptoms Checklist. The Hamilton Rating Scale for Depression and Diagnostic Interview Schedule were used to assess depressive severity and history of generalized anxiety or panic disorder, respectively. Symptoms resembling tricyclic side effects, including thirst (54%), palpitations (51%), and dry mouth (48%), were commonly experienced before commencing pharmacotherapy. Patients with severe depressive episodes and those with a history of an anxiety or panic disorder had significantly more physical symptoms than those with milder episodes of depression and were more likely to drop out of care (n = 25) before completing the acute phase of pharmacotherapy. Patients who completed the acute phase of pharmacotherapy and those who entered its continuation phase (n = 43) experienced significant reduction in many depressive and physical symptoms (p < .001).

Conclusions: Symptoms resembling tricyclic side effects are common among depressed primary care patients before beginning pharmacotherapy and generally remit with the depressive episode. Better awareness of major depression's somatic effects and the consequences of therapy could result in better management of both physicians' and patients' expectations regarding antidepressant pharmacotherapy.

Citing Articles

Occurrence of Side Effects in Treatment-Resistant Depression: Role of Clinical, Socio-Demographic and Environmental Characteristics.

Levy A, El-Hage W, Bennabi D, Allauze E, Bouvard A, Camus V Front Psychiatry. 2021; 12:795666.

PMID: 34938218 PMC: 8685450. DOI: 10.3389/fpsyt.2021.795666.

The Bypassing the Blues treatment protocol: stepped collaborative care for treating post-CABG depression.

Rollman B, Belnap B, LeMenager M, Mazumdar S, Schulberg H, Reynolds 3rd C Psychosom Med. 2009; 71(2):217-30.

PMID: 19188529 PMC: 4573662. DOI: 10.1097/PSY.0b013e3181970c1c.

Not all side effects associated with tricyclic antidepressant therapy are true side effects.

Thiwan S, Drossman D, Morris C, Dalton C, Toner B, Diamant N Clin Gastroenterol Hepatol. 2009; 7(4):446-51.

PMID: 19167522 PMC: 2702777. DOI: 10.1016/j.cgh.2008.11.014.

Use of psychopharmacological agents for functional gastrointestinal disorders.

Clouse R, Lustman P Gut. 2005; 54(9):1332-41.

PMID: 16099800 PMC: 3260562. DOI: 10.1136/gut.2004.048884.

Comorbidity of depression and anxiety in the elderly.

Lenze E Curr Psychiatry Rep. 2003; 5(1):62-7.

PMID: 12686004 DOI: 10.1007/s11920-003-0011-7.

References

Brown C, Schulberg H, Madonia M, Shear M, Houck P . Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders. Am J Psychiatry. 1996; 153(10):1293-300. DOI: 10.1176/ajp.153.10.1293. View

Sherbourne C, Jackson C, Meredith L, Camp P, Wells K . Prevalence of comorbid anxiety disorders in primary care outpatients. Arch Fam Med. 1996; 5(1):27-34; discussion 35. DOI: 10.1001/archfami.5.1.27. View

Schulberg H, Magruder K, deGruy F . Major depression in primary medical care practice. Research trends and future priorities. Gen Hosp Psychiatry. 1996; 18(6):395-406. DOI: 10.1016/s0163-8343(96)00093-x. View

Brown C, Schulberg H, Shear M . Phenomenology and severity of major depression and comorbid lifetime anxiety disorders in primary medical care practice. Anxiety. 1996; 2(5):210-8. DOI: 10.1002/(SICI)1522-7154(1996)2:5<210::AID-ANXI2>3.0.CO;2-Q. View

Schulberg H, Block M, Madonia M, Scott C, Lave J, Rodriguez E . The 'usual care' of major depression in primary care practice. Arch Fam Med. 1997; 6(4):334-9. DOI: 10.1001/archfami.6.4.334. View

Beck A, Ward C, Mendelson M, Mock J, ERBAUGH J . An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561-71. DOI: 10.1001/archpsyc.1961.01710120031004. View

STOECKLE J, DAVIDSON G . Bodily complaints and other symptoms of depressive reaction. Diagnosis and significance in a medical clinic. JAMA. 1962; 180:134-9. DOI: 10.1001/jama.1962.03050150040008. View

Lin E, von Korff M, Katon W, Bush T, Simon G, Walker E . The role of the primary care physician in patients' adherence to antidepressant therapy. Med Care. 1995; 33(1):67-74. DOI: 10.1097/00005650-199501000-00006. View

Asberg M, CRONHOLM B, Sjoqvist F, Tuck D . Correlation of subjective side effects with plasma concentrations of nortriptyline. Br Med J. 1970; 4(5726):18-21. PMC: 1820531. DOI: 10.1136/bmj.4.5726.18. View

10.

Asberg M . Plasma nortriptyline levels--relationship to clinical effects. Clin Pharmacol Ther. 1974; 16(1):215-29. View

11.

Endicott J, Spitzer R, Fleiss J, Cohen J . The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry. 1976; 33(6):766-71. DOI: 10.1001/archpsyc.1976.01770060086012. View

12.

Mathew R, Weinman M, Claghorn J . Tricyclic side effects without tricyclics in depression. Psychopharmacol Bull. 1980; 16(3):58-60. View

13.

ROBINS L, Helzer J, Croughan J, Ratcliff K . National Institute of Mental Health Diagnostic Interview Schedule. Its history, characteristics, and validity. Arch Gen Psychiatry. 1981; 38(4):381-9. DOI: 10.1001/archpsyc.1981.01780290015001. View

14.

Nelson J, Jatlow P, Quinlan D . Subjective complaints during desipramine treatment. Relative importance of plasma drug concentrations and the severity of depression. Arch Gen Psychiatry. 1984; 41(1):55-9. DOI: 10.1001/archpsyc.1984.01790120059008. View

15.

Myers E, Calvert E . Information, compliance and side-effects: a study of patients on antidepressant medication. Br J Clin Pharmacol. 1984; 17(1):21-5. PMC: 1463292. DOI: 10.1111/j.1365-2125.1984.tb04993.x. View

16.

Orleans C, George L, Houpt J, Brodie H . How primary care physicians treat psychiatric disorders: a national survey of family practitioners. Am J Psychiatry. 1985; 142(1):52-7. DOI: 10.1176/ajp.142.1.52. View

17.

Katon W, Vitaliano P, Russo J, Cormier L, Anderson K, Jones M . Panic disorder: epidemiology in primary care. J Fam Pract. 1986; 23(3):233-9. View

18.

Pollack M, Rosenbaum J . Management of antidepressant-induced side effects: a practical guide for the clinician. J Clin Psychiatry. 1987; 48(1):3-8. View

19.

Fawcett J, Epstein P, Fiester S, Elkin I, Autry J . Clinical management--imipramine/placebo administration manual. NIMH Treatment of Depression Collaborative Research Program. Psychopharmacol Bull. 1987; 23(2):309-24. View

20.

Kaplan C, Lipkin Jr M, Gordon G . Somatization in primary care: patients with unexplained and vexing medical complaints. J Gen Intern Med. 1988; 3(2):177-90. DOI: 10.1007/BF02596128. View