Pharmacotherapy Relapse Prevention in Body Dysmorphic Disorder: A Double-Blind, Placebo-Controlled Trial
Publication: American Journal of Psychiatry
Abstract
Objective:
Body dysmorphic disorder is common, distressing, and often severely impairing. Serotonin reuptake inhibitors appear efficacious, but the few existing pharmacotherapy studies were short term (≤4 months), and no relapse prevention studies or continuation phase studies have been conducted to the authors’ knowledge. The authors report results from the first relapse prevention study in body dysmorphic disorder.
Method:
Adults (N=100) with DSM-IV body dysmorphic disorder received open-label escitalopram for 14 weeks (phase 1); 58 responders were then randomized to double-blind continuation treatment with escitalopram versus switch to placebo for 6 months (phase 2). Reliable and valid outcome measures were utilized.
Results:
In phase 1, 67.0% of treated subjects and 81.1% of subjects who completed phase 1 responded to escitalopram. Body dysmorphic disorder severity (in both the intent-to-treat and the completer groups) and insight, depressive symptoms, psychosocial functioning, and quality of life significantly improved from baseline to end of phase 1. In phase 2, time to relapse was significantly longer with escitalopram than with placebo treatment (hazard ratio=2.72, 95% CI=1.01–8.57). Phase 2 relapse proportions were 18% for escitalopram and 40% for placebo. Among escitalopram-treated subjects, body dysmorphic disorder severity significantly decreased over time during the continuation phase, with 35.7% of subjects showing further improvement. There were no significant group differences in body dysmorphic disorder severity or insight, depressive symptoms, psychosocial functioning, or quality of life.
Conclusions:
Continuation-phase escitalopram delayed time to relapse, and fewer escitalopram-treated subjects relapsed than did placebo-treated subjects. Body dysmorphic disorder severity significantly improved during 6 additional months of escitalopram treatment following acute response; more than one-third of escitalopram-treated subjects experienced further improvement.
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History
Received: 30 September 2015
Revision received: 26 November 2015
Accepted: 4 January 2016
Published online: 8 April 2016
Published in print: September 01, 2016
Authors
Funding Information
National Institute of Mental Health10.13039/100000025: R01 MH072854, R01 MH072917
Supported by NIMH Collaborative R01 grants to Dr. Phillips (R01 MH072917) and Dr. Wilhelm (R01 MH072854). Study medication and matching placebo provided by Forest Laboratories.Dr. Phillips has received support from Oxford University Press (royalties), International Creative Management (royalties), American Psychiatric Association Publishing (honoraria), Merck Manual (honoraria), Abbott Laboratories (presentation), AstraZeneca (presentation), Global Medical Education (presentation), Janssen Research and Development (consultant), Transcept Pharmaceuticals (research funding), speaking honoraria and/or travel reimbursement from academic institutions and professional organizations, UpToDate (future honoraria), The Free Press (potential future royalties), and Guilford Press (potential future royalties). Dr. Dougherty has received research support from Cyberonics, Eli Lilly, Medtronic, and Roche; and he has received honoraria or travel support from Insys, Johnson & Johnson, Medtronic, and Roche. Mr. Menard has received support from Avid Radiopharmaceuticals, Biogen, Eli Lilly, Merck, and Transcept Pharmaceuticals. Dr. Wilhelm is a presenter for the Massachusetts General Hospital Psychiatry Academy that specializes in educational programs that are supported through independent medical education grants from pharmaceutical companies; she has received royalties from Elsevier, Guilford, New Harbinger Publications, and Oxford University Press; she has received research support from Novartis and honoraria from various academic institutions and foundations, including the International Obsessive Compulsive Disorder Foundation and the Tourette Syndrome Association; and she has received support from the Association for Behavioral and Cognitive Therapies for her role as associate editor of Behavior Therapy, as well as from John Wiley & Sons for her role as associate editor of Depression and Anxiety. Ms. Keshaviah and Dr. Stout report no financial relationships with commercial interests.Metrics & Citations
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