This article outlines critical issues in the psychiatric assessment of
patients presenting with medically unexplained physical symptoms that
form the core of the somatoform disorders in current nosologies, The
prevalence of these disorders in communities and clinical settings emp
hasizes that a majority of these patients are primary care service use
rs rather than mental health clients. A brief review of previous studi
es on the pharmacological management of these syndromes with antidepre
ssants highlights unique features of these disorders that are relevant
to the design of double-blind studies, The promising results emerging
from some of these studies bring new excitement to the field that may
help counter the prevailing therapeutic nihilism, thus attracting new
investigators to this area, Finally, several caveats are provided on
issues of research design and interpretation for the benefit of those
entering this field of research.