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Original Research

Underrecognition of Clinically Significant Side Effects in Depressed Outpatients

Mark Zimmerman, MD; Janine N. Galione, BS; Naureen Attiullah, MD; Michael Friedman, MD; Cristina Toba, MD; Daniela A. Boerescu, MD; and Moataz Ragheb, MD

Published: April 15, 2010

Article Abstract

Objective: The presence of medication side effects is one of the most frequent reasons depressed patients discontinue medication, and premature discontinuation of medication is associated with poorer outcome in the treatment of depression. Despite the clinical importance of detecting side effects, few studies have examined the adequacy of their detection and documentation by clinicians. We are not aware of any studies comparing psychiatrists’ clinical assessments to a standardized side effects checklist in depressed patients receiving ongoing treatment in clinical practice. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to test the hypothesis that fewer side effects would be recorded by psychiatrists in their patients’ charts compared to the number reported by patients on a side effects checklist.

Method: Three hundred depressed outpatients (diagnosed according to DSM-IV criteria) in ongoing treatment completed a self-administered version of the Toronto Side Effects Scale (TSES). The patients rated the frequency of each of the 31 side effects and the degree of trouble caused by them. A research assistant reviewed patients’ charts to extract side effects information recorded by the treating psychiatrist. The study was conducted from June 2008 to July 2008.

Results: The mean number of side effects reported by the patients on the TSES was 20 times higher than the number recorded by the psychiatrists (P < .01). When the self-reported side effects were limited to frequently occurring or very bothersome side effects, the rate was still 2 to 3 times higher (P < .01).

Conclusions: Psychiatrists may not be aware of most side effects experienced by psychiatric outpatients receiving ongoing pharmacologic treatment for depression.

J Clin Psychiatry 2010;71(4):484-490

Submitted: December 22, 2008; accepted February 12, 2009.

Corresponding author: Mark Zimmerman, MD, Bayside Medical Center, 235 Plain Street, Providence, RI 02905 (

Volume: 71

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