Urge to Splurge

TO THE EDITOR: We read with interest the article on uncontrolled buying by Michel Lejoyeux, M.D., Ph.D., and colleagues (1). They review a topic of growing importance but failed to note our previous work in the area (2). In a group of 46 persons with compulsive buying, we found substantial comorbidity (mood, anxiety, substance use, and impulse control disorders). Over one-half met criteria for a personality disorder, but a special personality profile as suggested by Lejoyeux et al. was not found. We believe that “primary” uncontrolled buyers (i.e., without comorbidity) must be rare.

Lejoyeux and colleagues will be interested to learn that we have recently presented preliminary data from an uncontrolled trial in which 10 nondepressed subjects were treated with fluvoxamine (mean dose=205 mg/day) (3). Nine subjects had greater than 50% improvement in scores on the Yale-Brown Obsessive Compulsive Scale—Shopping Version, a modification of the original instrument that we have shown to have excellent reliability and validity (3, 4). A randomized, double-blind trial of fluvoxamine versus placebo is now underway. On the basis of prior case reports, Lejoyeux et al. suggest that the effect of antidepressant treatment is “especially marked when uncontrolled buying was associated with a depression.” In fact, these medications have a variety of effects that have little to do with mood, and, as we have shown, improvement with fluvoxamine was unrelated to mood state.