Long-term outcome from tricyclic antidepressant treatment of functional chest pain

Antidepressants are of demonstrated value in short-term treatment of functi onal chest pain, but long-term outcome data are unavailable, Follow-up info rmation over a median of 2.7 years (0.8-8.6 years) was systematically obtai ned from 21 outpatients treated with tricyclic antidepressants after incomp lete response to antireflux therapy. Initial treatment produced at least mo derate symptom reduction or remission in 17 subjects (81.0%). Of these, 7 ( 41.2%) were successfully treated continuously or for symptom relapses over an average of 2.6 years; rs: 5 (29.4%) discontinued successful treatment af ter >0.5 years with sustained benefits; and 5 (29.4%) eventually discontinu ed treatment because of side effects or for uncertain reasons (1 having a s ustained remission). Low-dose tricyclic antidepressants were considered the most effective long-term chest pain treatment significantly more often tha n were antireflux medications or calcium-channel blockers in this selected patient group (P < 0.05 for each), We conclude from this retrospective revi ew that fully three fourths of subjects with functional chest pain who init ially respond to open-label treatment with law-dose tricyclic antidepressan ts will use them continuously or for symptom relapses over at least the nex t two to three years and consider them the most effective treatment for the ir symptoms.