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Maxwell Sobel, MD
Indiana University School of Medicine Indianapolis

JAMA. 1988;260(21):3129-3130.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor. —

In the July 15 issue of JAMA, Dr Renshaw¹ presents a case discussion of the use of a tricyclic antidepressant in treating a young woman with interstitial cystitis and depression. While I found the case interesting, I take issue with the assumption that the presence of anticholinergic side effects means a therapeutic blood level has been attained. This is simply not a reliable estimate of efficacy. There seems to be little or no relationship between established therapeutic blood levels of tricyclic antidepressants and the anticholinergic side effects seen in approximately 15% of patients taking these agents.²

The presence of "dry mouth and eyes" only signifies the patient's individual sensitivity to this effect. I have seen several patients develop these side effects when taking small doses with negligible blood levels, far below levels shown to be therapeutic. The custom of predicting blood levels and determining . . . [Full Text PDF of this Article]

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