Antidepressantsin the Medicallylii: Diagnosisand Treatment in PrimaryCare

Major depressionis one of the most commonclinicalproblemsseen by primary-carephysicians.The prevalenceis 5% to 10% in primary-careoutpatientsand 15% in medicallyill inpatients. Despite this high prevalence rate, depression is frequently not accurately diagnosed. Evidence suggests that misdiagnosis often occurs because patients with depression frequently focus preferentially on somatic complaints or amplify complaintsof chronic medical illness.The tricyclic antidepressantsare more effective than placebo, both in treating medically ill patients with depressionand primarycare patientswith majordepression.Commonsideeffectsof the tricyclic antidepressants such as the anticholinergic, cardiac, and blood-pressureproblems are reviewed, with emphasis on the use of specific tncyclics in medically ill populations.