Psychotropic drugs

Antidepressant drugs are sometimes effective for somatic complaints including pain, even if the patient is not overtly depressed, and neuroleptic drugs such as trifluoperazine or pimozide may control somatic delusions and hallucinations.

Case example

A man of 48 was made redundant from an unskilled factory job, and could not find further work. He started to suffer severe headaches, and consulted his GP several times. The GP's impression of a depressive component was vehemently rejected by the patient, and there seemed no alternative to neurology referral. While waiting for outpatient consultation, the patient's pain became incapacitating over a weekend and he was admitted as an emergency. During a 2-week admission, he had extensive investigations, all of which were normal, and continued to refuse the ward staff's efforts to encourage him to talk about his apparent emotional problems. He was discharged with a diagnosis of 'tension headache, depressed' on amitripty-line 50 mg nocte, in the belief that this drug was purely an analgesic. He continued to suffer headaches, and to decline more intensive psychiatric input. In follow-up, he never regained full physical or psychological health, although it was clear that he was rather better when taking amitriptyline than when not.

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