Somatic Symptom Disorders Medication
- Author: William R Yates, MD, MS; Chief Editor: Eduardo Dunayevich, MD more...
Somatic symptom disorder
Based on studies of somatization disorder, medication approaches rarely are successful for this condition. Physicians should search for evidence of psychiatric comorbidity, such as depression or an anxiety disorder. If present, medication interventions specific to the diagnosis can be attempted. Successful treatment of a major depression or an anxiety disorder, such as panic disorder, also may produce significant reduction in somatization disorder.
A recent clinical trial in China found a combination of the serotonin reuptake inhibitors (SSRI) citalopram with the atypical antidepressant paliperidone to be more effective than citalopram alone for the treatment of a group of mixed group of somatoform disorder subjects.
Nonmedication strategies are the most successful. See psychosocial treatment in Medical Care for more details.
Hypochondriasis may be a feature of a mood or anxiety disorder. Pharmacologic treatment of the mood or anxiety disorder may reduce hypochondriacal symptoms. If a mood or anxiety disorder is present, see Medical Care. Group psychotherapy is very effective in a medical setting.
No specific pharmacological interventions have been shown to be effective for conversion disorder.
Imipramine is a tricyclic antidepressant that has demonstrated clear superiority over the placebo in double-blind trials for treating specific symptoms of bulimia nervosa. However, SSRIs (eg, fluoxetine) probably should be first-line agents.
SSRIs are greatly preferred over the other classes of antidepressants. Because the adverse effect profile of SSRIs is less prominent, improved compliance is promoted. SSRIs do not have the cardiac arrhythmia risk associated with tricyclic antidepressants. Arrhythmia risk is especially pertinent in overdose, and suicide risk must always be considered when treating a child or adolescent with mood disorder.
Physicians are advised to be aware of the following information and use appropriate caution when considering treatment with SSRIs in the pediatric population.
In December 2003, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) issued an advisory that most SSRIs are not suitable for use by persons younger than 18 years for treatment of "depressive illness." After review, this agency decided that the risks to pediatric patients outweigh the benefits of treatment with SSRIs, except fluoxetine (Prozac), which appears to have a positive risk-benefit ratio in the treatment of depressive illness in patients younger than 18 years.
In October 2003, the US Food and Drug Administration (FDA) issued a public health advisory regarding reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive disorder. This advisory reported suicidality (both ideation and attempts) in clinical trials of various antidepressant drugs in pediatric patients. The FDA has asked that additional studies be performed because suicidality occurred in both treated and untreated patients with major depression and thus could not be definitively linked to drug treatment.
Imipramine inhibits reuptake of norepinephrine or serotonin (5-hydroxytryptamine, 5-HT), at presynaptic neurons. It is one of the oldest agents available for the treatment of depression and has established efficacy in the treatment of panic disorder. Geriatric and adolescent patients may need lower dosing or slower titration.
Fluoxetine selectively inhibits presynaptic serotonin reuptake with minimal or no effect in the reuptake of norepinephrine or dopamine.
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