title: Symptoms of major depression and tricyclic side effects in primary care patients.
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.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Seventy-five patients meeting DSM-III-R criteria for a current major depression.
  
  
  METHODS
  Four Pittsburgh (Pa.) ambulatory health centers affiliated with residency programs.
  
  
  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.
authors.affiliation: Division of General Internal Medicine, Western Pennsylvania Hospital, Pittsburgh, USA.
authors.forename: B L
authors.initials: BL
authors.lastname: Rollman
authors.forename: M R
authors.initials: MR
authors.lastname: Block
authors.forename: H C
authors.initials: HC
authors.lastname: Schulberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects* / Q000627:therapeutic use; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy*; D003937:Diagnosis, Differential; D004066:Digestive System Diseases / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology; D009661:Nortriptyline / Q000009:adverse effects* / Q000627:therapeutic use; D011320:Primary Health Care; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic; D009661:Nortriptyline