The Effect of Forewarning on the Occurrence of Side-effects and Discontinuance of Medication in Patients on Amitriptyline

It is generally accepted that psychological factors are of importance in determining the effects of drugs—beneficial or adverse (Green, 1964; Wilson, 1966; Boszormenyi, 1969). Placebo studies have suggested that one such psychological factor may be prior knowledge of side-effects (Wolf, 1950; M.R.C., 1950; Coleman, 1969). In a controlled trial of amitriptyline in general practice (Blashki et al. , 1971) the patients were asked to record their experience of side-effects on a prepared list, and it was thought that this might have ‘involved the risk of suggesting side-effects to the patients'. In a controlled trial of Imipramine in general practice (Porter, 1970) the data suggested that side-effects were an important cause for patients abandoning treatment. Doctors may be chary of detailing side-effects, thinking that imparting such knowledge to patients may in a proportion of them induce the side-effects to appear and lead to discontinuance of therapy.