Further complicating the issue is the fact that psychotherapy and psychiatric care are severely limited or not covered at all by many insurance plans. However, the following general comments may be of value to interested readers. Co-morbidity is a contributing factor, with substance abuse, anxiety, and other medical conditions complicating diagnosis. Clearly, clinicians need to maintain the proverbial high index of suspicion. Also, their use of a brief screening tool, such as the Zung Depression Scale, can be very helpful.
Tricyclic antidepressants are no longer the mainstay of pharmacotherapy for depression.
Better results can be achieved with these drugs if patients are seen weekly during the first month of treatment for dosage adjustment, reassurance, and monitoring for the development of hypotension and cardiac conduction defects. Although these drugs are widely prescribed by primary care physicians, their side effects frequently lead to inconsistent patient compliance and thus clinical response. In addition, these drugs, which are poorly tolerated by the geriatric population, have the potential to cause serious cardiac side effects. Moreover, of all prescription drugs, the tricyclic antidepressants are the leading cause of hospitalization and death due to overdose. Still, they are less expensive than newer psychotropic drugs and remain useful in patients who can tolerate them.