In the Journals

Escitalopram prevents relapse in body dysmorphic disorder

Escitalopram delayed time to relapse and lowered risk for relapse among adults with body dysmorphic disorder, according to recent findings.

“This research yielded clinically important data about [body dysmorphic disorder], a common, often-chronic and understudied illness in need of more evidence-based treatment,” Katharine A. Phillips, MD, of Rhode Island Hospital and Alpert Medical School, Brown University, said in a press release. “We showed that the risk of relapse can be substantially reduced by continuing effective medication and also that the continuation of medication after the acute period can further improve symptoms.”

To assess efficacy of pharmacotherapy for relapse prevention in body dysmorphic disorder, researchers assigned 100 adults with DSM-IV body dysmorphic disorder to open-label escitalopram for 14 weeks. Fifty-eight participants were then randomly assigned to receive double-blind continuation treatment with escitalopram or placebo for 6 months.

During the 14-week phase one, 67% of the intent-to-treat population and 81.1% of participants who completed phase one responded to escitalopram.

Body dysmorphic disorder severity and insight, depressive symptoms, psychosocial functioning and quality of life significant improved from baseline to the end of phase one among both the intent-to-treat population and phase one completers.

In phase two, time to relapse was significantly longer among participants who received escitalopram compared with those who received placebo (HR = 2.72; 95% CI, 1.01-8.57).

Relapse occurred during phase two among 18% of the escitalopram group and 40% of the placebo group.

During the continuation phase, body dysmorphic disorder severity significantly decreased over time among participants who received escitalopram, with 35.7% of participants improving.

There were no significant differences in body dysmorphic disorder severity or insight, depression symptoms, psychosocial functioning or quality of life between groups.

“Among patients who responded to acute-phase escitalopram, continued pharmacological treatment significantly delayed time to relapse compared to patients in the placebo group. Further, more than twice as many placebo-treated patients relapsed than escitalopram-treated patients,” study researcher Sabine Wilhelm, PhD, of Massachusetts General Hospital, said in the release. “This is important data for providers treating patients with [body dysmorphic disorder]. Research studies are also needed that investigate whether treatment with [cognitive behavioral therapy] for [body dysmorphic disorder] will decrease the risk of relapse when an effective medication is stopped.” – by Amanda Oldt

Disclosure: Phillips reports receiving 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). Please see the full study for a list of all authors’ relevant financial disclosures.

Escitalopram delayed time to relapse and lowered risk for relapse among adults with body dysmorphic disorder, according to recent findings.

“This research yielded clinically important data about [body dysmorphic disorder], a common, often-chronic and understudied illness in need of more evidence-based treatment,” Katharine A. Phillips, MD, of Rhode Island Hospital and Alpert Medical School, Brown University, said in a press release. “We showed that the risk of relapse can be substantially reduced by continuing effective medication and also that the continuation of medication after the acute period can further improve symptoms.”

To assess efficacy of pharmacotherapy for relapse prevention in body dysmorphic disorder, researchers assigned 100 adults with DSM-IV body dysmorphic disorder to open-label escitalopram for 14 weeks. Fifty-eight participants were then randomly assigned to receive double-blind continuation treatment with escitalopram or placebo for 6 months.

During the 14-week phase one, 67% of the intent-to-treat population and 81.1% of participants who completed phase one responded to escitalopram.

Body dysmorphic disorder severity and insight, depressive symptoms, psychosocial functioning and quality of life significant improved from baseline to the end of phase one among both the intent-to-treat population and phase one completers.

In phase two, time to relapse was significantly longer among participants who received escitalopram compared with those who received placebo (HR = 2.72; 95% CI, 1.01-8.57).

Relapse occurred during phase two among 18% of the escitalopram group and 40% of the placebo group.

During the continuation phase, body dysmorphic disorder severity significantly decreased over time among participants who received escitalopram, with 35.7% of participants improving.

There were no significant differences in body dysmorphic disorder severity or insight, depression symptoms, psychosocial functioning or quality of life between groups.

“Among patients who responded to acute-phase escitalopram, continued pharmacological treatment significantly delayed time to relapse compared to patients in the placebo group. Further, more than twice as many placebo-treated patients relapsed than escitalopram-treated patients,” study researcher Sabine Wilhelm, PhD, of Massachusetts General Hospital, said in the release. “This is important data for providers treating patients with [body dysmorphic disorder]. Research studies are also needed that investigate whether treatment with [cognitive behavioral therapy] for [body dysmorphic disorder] will decrease the risk of relapse when an effective medication is stopped.” – by Amanda Oldt

Disclosure: Phillips reports receiving 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). Please see the full study for a list of all authors’ relevant financial disclosures.