Somatoform Disorders Medication

  • Author: William R Yates, MD, MS; Chief Editor: Eduardo Dunayevich, MD   more...
 
Updated: Aug 3, 2010
 

Medication Summary

Somatization disorder: For people with somatization disorder, medication approaches rarely are successful. 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. Nonmedication strategies are the most successful. See psychosocial treatment in Medical Care for more details.

Hypochondriasis: 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.

Conversion disorder: No specific pharmacological interventions have been shown to be effective for conversion disorder.

Pain disorder: Analgesic therapy often is ineffective for somatoform disorders characterized a pain disorder. Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI) may be helpful.

Body dysmorphic disorder: Randomized controlled trials demonstrate that selective serotonin reuptake inhibitors reduce symptoms in as many as one half of individuals with body dysmorphic disorders. Case reports have suggested improvement with other agents, including monoamine oxidase inhibitors, tricyclic antidepressants, and the pimozide (an antipsychotic).

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Antidepressants

Class Summary

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.

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Imipramine (Tofranil)

 

Inhibits reuptake of norepinephrine or serotonin (5-hydroxytryptamine, 5-HT), at presynaptic neuron. 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.

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Fluoxetine (Prozac)

 

Selectively inhibits presynaptic serotonin reuptake with minimal or no effect in the reuptake of norepinephrine or dopamine.

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Contributor Information and Disclosures
Author

William R Yates, MD, MS  Research Psychiatrist, Laureate Institute for Brain Research; Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa

William R Yates, MD, MS is a member of the following medical societies: American Academy of Family Physicians and American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mohammed A Memon, MD  Chairman and Attending Geriatric Psychiatrist, Department of Psychiatry, Spartanburg Regional Medical Center

Mohammed A Memon, MD is a member of the following medical societies: American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

Eduardo Dunayevich, MD  Adjunct Assistant Professor, Department of Psychiatry, University of Cincinnati; Clinical Research Physician, Neuroscience, Lilly Research Laboratories

Eduardo Dunayevich, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

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