Bodily Complaints and Other Symptoms of Depressive Reaction

Stoeckle, John D.; Davidson, Gerald E.

doi:10.1001/jama.1962.03050150040008

Cited by 40 publications

(8 citation statements)

References 6 publications

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“…As in earlier reports about primary care patients, [17][18][19] our analyses support the observation that somatic symptoms resembling side effects of tricyclic antidepressants are often present among depressed primary care patients before the initiation of pharmacotherapy. In addition, we found patients with more severe depressive symptoms and those with a comorbid panic disorder to experience higher levels of somatic symptoms resembling tricyclic side effects before initiating pharmacotherapy than other depressed individuals.…”

Section: Discussionsupporting

confidence: 89%

“…Symptoms resembling the side effects of tricyclic antidepressants have been found among depressed psychiatric, [13][14][15] geriatric, 16 and primary care [17][18][19] patients even before these medications were provided them. Given these earlier reports, more information is needed about the relation between subjective symptoms resembling tricyclic side effects and the severity of the depressive episode along with the influence of a comorbid anxiety disorder on these symptoms.…”

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confidence: 99%

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

1997

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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 reductions in many depressive and physical symptoms ( p Ͻ .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 patents' expectations regarding antidepressant pharmacotherapy. KEY WORDS: major depression; primary care; pharmacotherapy; nortriptyline; adverse effects. J GEN INTERN MED 1997;12:284-291.ajor depression is experienced by 6% to 8% of primary care patients, 1 and is associated with significant psychic distress and functional disability. 2-5 A metaanalysis of randomized clinical trials by the Depression Guideline Panel of the Agency For Health Care Policy and Research concluded, however, that most episodes of this disorder can be resolved efficaciously when antidepressant medications are prescribed at proper dosages and for adequate durations. 6 Thus, it is of concern that primary care physicians often prescribe these drugs at dosages too low to achieve therapeutic benefits and for periods too brief to prevent relapse. [7][8][9][10][11] The rationale guiding prescribing practices of primary care physicians has been the subject of much speculation. One possibility for why antidepressant medications, particularly of the tricyclic type, are prescribed at subtherapeutic dosages is that they produce disturbing side effects for patients who already are highly sensitive to the psychological and somatic symptoms associated with their depressive illness. Medication-induced discomfor...

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

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

1997

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“…Presumably physicians prescribe antidepressants at quite low initial and continuing dosages so that discomforts are better tolerated and participation in treatment is sustained. 12 Still, the physician must consider whether the discomforting psychological and somatic symptoms attributed to the antidepressant medication are actually manifestations of the mood disorder itself.Symptoms resembling the side effects of tricyclic antidepressants have been found among depressed psychiatric, 13-15 geriatric, 16 and primary care [17][18][19] patients even before these medications were provided them. Given these earlier reports, more information is needed about the relation between subjective symptoms resembling tricyclic side effects and the severity of the depressive episode along with the influence of a comorbid anxiety disorder on these symptoms.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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

1997

View full text Add to dashboard Cite

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 reductions in many depressive and physical symptoms ( p Ͻ .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 patents' expectations regarding antidepressant pharmacotherapy. ajor depression is experienced by 6% to 8% of primary care patients, 1 and is associated with significant psychic distress and functional disability. 2-5 A metaanalysis of randomized clinical trials by the Depression Guideline Panel of the Agency For Health Care Policy and Research concluded, however, that most episodes of this disorder can be resolved efficaciously when antidepressant medications are prescribed at proper dosages and for adequate durations. 6 Thus, it is of concern that primary care physicians often prescribe these drugs at dosages too low to achieve therapeutic benefits and for periods too brief to prevent relapse. [7][8][9][10][11] The rationale guiding prescribing practices of primary care physicians has been the subject of much speculation. One possibility for why antidepressant medications, particularly of the tricyclic type, are prescribed at subtherapeutic dosages is that they produce disturbing side effects for patients who already are highly sensitive to the psychological and somatic symptoms associated with their depressive illness. Medication-induced discomforts such as thirst, dry mouth, palpitations, and dizziness, which are most marked early in the course of treatment, could lead ...

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“…Thus, differentiating side effects of TCAs from other somatic symptoms often reported by these patients becomes a difficult task as this may either reflect patient’s general tendency to report somatic symptoms, or amplification of this tendency by the underlying psychosocial distress 13. This phenomenon, first reported among depressed patients seen in psychiatry 14, 15 and primary care13, 16, 17 has not been adequately studied in patients with functional GI disorders. This distinction is clinically relevant since it may affect the patient’s adherence to treatment and the physician’s prescribing behaviors.…”

Section: Introductionmentioning

confidence: 99%

Not All Side Effects Associated With Tricyclic Antidepressant Therapy Are True Side Effects

Thiwan

Drossman

Morris

et al. 2009

Clinical Gastroenterology and Hepatology

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Objectives-Patients with functional gastrointestinal (GI) disorders treated with tricyclic antidepressants may report non-GI symptoms. It is unclear whether these symptoms are side effects of the medication or reflect a general behavioral tendency to report symptoms. This study 1) evaluated whether a checklist of symptoms reported by patients prior to taking desipramine increased in number or worsened in severity after being on a tricyclic antidepressant (desipramine), and 2) assessed baseline factors that predispose patients to report symptoms.Methods-Female patients in the drug arm of a multi-center NIH treatment trial for functional bowel disorders completed a 15 item symptom questionnaire at baseline before randomization and at 2 weeks after starting Desipramine (n=81), or placebo (n=40) and at study completion 12 weeks later. Patients were asked on each occasion if they experienced any of 15 Symptoms and its level of severity and frequency, and the results were compared.Results-A total of 57 patients in the desipramine arm who completed the questionnaire at both week 0 and week 2 comprised the study sample. Certain symptoms reported as side effects: dizziness, dry mouth/thirstiness, lightheadedness, feeling jittery or tremors and flushing not only were reported more often but also worsened at week 2 indicating a drug effect. Conversely, other symptoms that were also reported as side effects: feeling tired in AM, nausea, blurred vision, headaches, decreased appetite, and trouble sleeping either did not change in severity or showed improvement at week 2 (tiredness). All these symptoms except trouble sleeping were reported less often at Week 2 than at baseline (Week 2). Psychological distress but not desipramine level significantly correlated with symptom reporting.Conclusions-The majority of symptoms often attributed to side effects of desipramine were present prior to treatment, and only a few related to its anticholinergic effects worsened 2 weeks after beginning treatment, suggesting that most symptoms considered as side effects were not related to drug per se. Clinicians should consider that "Side effects" may relate more to psychological distress than to drug effects.

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Bodily Complaints and Other Symptoms of Depressive Reaction

Cited by 40 publications

References 6 publications

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

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

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

Not All Side Effects Associated With Tricyclic Antidepressant Therapy Are True Side Effects

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