Pharmacotherapy

There are no medications approved by a regulatory body in any country for the treatment of BDD; however, SSRI treatments have been shown to be effective in treating the symptoms of BDD. Given the efficacy demonstrated by fluoxetine and clomipramine, there is reason to believe that the other SSRIs may be effective for BDD (class effect).

The most robust pharmacotherapy at this time is fluoxetine, although at higher doses than used in depressive or anxiety disorders. We recommend titrating fluoxetine to a dose of at least 60mg/ day, depending upon tolerability and efficacy at lower doses.

Should fluoxetine fail or if the patient has already taken an adequate course of the medication, then the tricyclic clomipramine should be started at 25-50mg/day, with dose increasing by 50mg every five days. After reaching 150mg/day, the clinician can wait four weeks to judge effectiveness, and then further increase the dose in steps of 50mg every five days as needed. The average target dose is 100-250mg/day, with usual maximum dose being 250mg/ day.

It is important to note that antipsychotic medications have not been helpful for individuals with BDD. BDD patients with delusions should be treated with SRIs, not antipsychotic medications.

Risks/Side Effects

All patients with BDD and co-occurring Major Depressive Disorder or symptoms of depression who are taking antidepressant medications should be alerted to the risk of clinical worsening of depressive symptoms and suicidal ideation which have been linked to the use of these medications. Parents or guardians of children who are prescribed antidepressants, regardless of depression history, should be alerted to this risk. Patients taking clomipramine should also be alerted to the increased risk of seizure associated with taking clomipramine. Other side effects associated with clomipramine include nausea, diarrhea, loss of appetite, dry mouth, increased anxiety, blurred vision, dizziness, constipation, trouble concentrating, insomnia, drowsiness, nightmares, increased sweating, decreased libido, impotence, and difficulties having an orgasm.

 
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