Pediatric Illness Anxiety Disorder (Formerly Hypochondriasis) Medication

Updated: Jan 30, 2019
  • Author: Maria Sandra Cely-Serrano, MD; Chief Editor: Caroly Pataki, MD  more...
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Medication

Medication Summary

A review of somatoform disorder management in several adult psychiatric consultation-liaison services showed that recommendations were made for antidepressants in 40% of the patients, anxiolytics in 18%, sedatives in 18%, and antipsychotics in 10%. Pharmacologic management was consistent with comorbid psychiatric diagnoses of mood disorder in 39% of patients, of personality disorder in 37%, and of psychoactive substance use disorder in 19%.

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Selective serotonin reuptake inhibitors (SSRIs)

Class Summary

SSRIs are chemically unrelated to the tricyclic, tetracyclic, or other available antidepressants. They inhibit CNS neuronal uptake of serotonin (5HT). They may also have a weak effect on norepinephrine and dopamine neuronal reuptake. They have also been used to treat anxiety, phobias, and obsessive-compulsive disorders. Growing evidence suggests the efficacy of SSRIs to treat hypochondriasis. Although controlled adult trials using fluoxetine revealed a high rate of improvement, many patients responded as well to a placebo. Medication has been particularly helpful when comorbid conditions (eg, anxiety disorder, depression) are associated with hypochondriasis.

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.

However, one 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. [24] This is the largest study to date to address this issue.

Currently, evidence does not associate obsessive compulsive disorder and other anxiety disorders treated with SSRIs with an increased risk of suicide. For more information, see the FDA Web site on Antidepressant Use in Children, Adolescents, and Adults.

Fluoxetine (Prozac)

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

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