Clomipramine vs desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness.
BACKGROUND
Body dysmorphic disorder (preoccupation with an imagined or slight defect in appearance) is a common and disabling disorder associated with high rates of delusional symptoms and suicide attempts. Although preliminary studies suggest that serotonin reuptake inhibitors may be effective for body dysmorphic disorder, to date no controlled treatment studies have been published.


METHODS
Forty patients were enrolled and 29 were randomized into a 16-week, double-blind, crossover-design study of clomipramine, a potent serotonin reuptake inhibitor, and active control desipramine, a selective norepinephrine reuptake inhibitor. Outcome measures included specific ratings of body dysmorphic disorder severity, delusionality, and functional impairment.


RESULTS
Clomipramine was superior to desipramine in the acute treatment of body dysmorphic disorder symptoms as measured by assessment of patients' obsessive preoccupation with perceived body defects, repetitive behaviors in response to this preoccupation, and global ratings of symptom severity. Treatment efficacy was independent of the presence or severity of comorbid diagnoses of obsessive-compulsive disorder, depression, or social phobia. Likewise, clomipramine was equally effective regardless of whether the patients had insight or held their dysmorphic misperception with delusional intensity. Clomipramine was also superior to desipramine in improving functional disability.


CONCLUSIONS
Clomipramine is more effective than desipramine in the treatment of body dysmorphic disorder and is effective even among those patients who are delusional.
Hollander
E
E
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
Allen
A
A
Kwon
J
J
Aronowitz
B
B
Schmeidler
J
J
Wong
C
C
Simeon
D
D
D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000328:Adult; D002997:Clomipramine / Q000627:therapeutic use*; D015897:Comorbidity; D018592:Cross-Over Studies; D003702:Delusions / Q000188:drug therapy / Q000523:psychology; D003891:Desipramine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
D018759:Adrenergic Uptake Inhibitors; D002997:Clomipramine; D003891:Desipramine; D017367:Selective Serotonin Reuptake Inhibitors