Body Dysmorphic Disorder Medication
- Author: Sing-Yi Feng, MD; Chief Editor: Caroly Pataki, MD more...
Medication Summary
In recent years, SSRIs have appeared to be useful in the treatment of body dysmorphic disorder (BDD). Other classes of drugs, including tricyclic antidepressants (TCAs), benzodiazepines, neuroleptics, and anticonvulsants, have produced minimal or no improvement. In general, medication use is recommended in conjunction with psychosocial interventions such as cognitive-behavioral therapy.
Selective serotonin reuptake inhibitors (SSRIs)
Class Summary
These agents are used in the treatment of BDD. They are antidepressant agents that are chemically unrelated to the tricyclic, tetracyclic, or other available antidepressants. They inhibit CNS neuronal uptake of serotonin (5HT). They may have a weak effect on norepinephrine and dopamine neuronal reuptake and have been used to treat patients with anxiety, phobias, or OCDs.
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 TCAs. 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.
However, a recent study of more than 65,000 children and adults treated for depression between 1992 and 2002 by the Group Health Cooperative in Seattle found that suicide risk declines, not rises, with the use of antidepressants.[7] This is the largest study to date to address this issue.
Currently, no evidence associates OCD and other anxiety disorders treated with SSRIs with an increased risk of suicide.
Fluvoxamine (Luvox)
Potent selective inhibitor of neuronal serotonin reuptake. Does not significantly bind to alpha-adrenergic, histamine, or cholinergic receptors and, thus, has fewer adverse effects than TCAs. FDA-approved for children with OCD.
Fluoxetine (Prozac)
Selectively inhibits presynaptic serotonin reuptake with minimal or no effect in the reuptake of norepinephrine or dopamine. FDA-approved for OCD and major depressive disorder in children 8 y and older.
Tricyclic antidepressant agents (TCAs)
Class Summary
These agents are used when SSRIs are ineffective. They are structurally related to the phenothiazine antipsychotic agents and exhibit 3 major pharmacologic actions in varying degrees (ie, amine pump inhibition, sedation, anticholinergic action [peripheral and central]). They inhibit reuptake of norepinephrine or serotonin (ie, 5-hydroxytryptamine, 5-HT) at the presynaptic neuron.
Physicians should be cautious when using this particular class of medication because overdose has the potential to be deadly. Patients with BDD may have higher risk of suicidal behavior; thus, the potential harm to the patient in an overdose situation should be considered when choosing the type of antidepressant.
Clomipramine (Anafranil)
Affects serotonin uptake while it affects norepinephrine uptake when converted into its metabolite desmethylclomipramine.
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