Symptoms of major depression and tricyclic side effects in primary care patients

J Gen Intern Med. 1997 May;12(5):284-91. doi: 10.1046/j.1525-1497.1997.012005284.x.


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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analysis of Variance
  • Antidepressive Agents, Tricyclic / adverse effects*
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Cognition Disorders / diagnosis
  • Cognition Disorders / etiology
  • Cohort Studies
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / drug therapy*
  • Diagnosis, Differential
  • Digestive System Diseases / diagnosis
  • Digestive System Diseases / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nervous System Diseases / diagnosis
  • Nervous System Diseases / etiology
  • Nortriptyline / adverse effects*
  • Nortriptyline / therapeutic use
  • Primary Health Care
  • Prognosis
  • Prospective Studies
  • Severity of Illness Index
  • Treatment Outcome


  • Antidepressive Agents, Tricyclic
  • Nortriptyline