Fluoxetine: Effective, Safe for Hypochondriasis

Fluoxetine is a safe and effective treatment for patients with hypochondriasis, according to study published in the August issue of the American Journal of Psychiatry.

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“Fluoxetine is clearly beneficial and extremely well tolerated by hypochondriasis patients who generally have been difficult to treat,” Brian Fallon, M.D., director of the Center for Neuroinflammatory Disorders and Biobehavioral Medicine at Columbia University, told Psychiatric News.

Although hypochondriasis was not retained as a diagnosis in DSM-5, illness anxiety disorder and somatic symptom disorder both feature health and illness anxiety as a prominent symptom. “The results from this trial can be applied to many individuals suffering with these two specific disorders,” said Fallon.

Together with Arthur Barsky, M.D., of Harvard Medical School and Brigham Women’s Hospital in Boston, Fallon and colleagues randomly assigned 195 adults with DSM-IV hypochondriasis to one of four treatment conditions: placebo, cognitive-behavioral therapy (CBT), fluoxetine, or joint treatment with both fluoxetine and CBT for 24 weeks.

Patients assigned to CBT received six in-person, 60-minute weekly sessions with a therapist, followed by two biweekly and three monthly booster sessions. CBT treatment emphasized psychoeducation, reformulation of dysfunctional assumptions about symptoms, reduction of maladaptive sick role behaviors, identification of situations that exacerbated health anxiety, and reduction of bodily hypervigilance.

Patients assigned to fluoxetine received the medication on a fixed-flexible dosing regimen, beginning at 10 mg daily and increasing as tolerated and needed to 80 mg/day. 

At the start of the trial and again at 6, 12, and 24 weeks later, the patients underwent a battery of tests, which assessed hypochondriacal symptoms, other psychopathology, adverse events, functional status, and quality of life.

The researchers compared the proportion of responders in each treatment group. Response was defined as improvement of at least 25 percent over baseline scores on both the Whiteley Index and the Yale-Brown Obsessive Compulsive Scale for hypochondriasis (H-YBOCS-M).

The researchers found that patients who received fluoxetine, CBT, or a combination of the two had better response rates than those who received placebo (41.84 percent in the individual active treatment group and 47.17 percent in the joint treatment group compared with 29.55 percent in the placebo group). Secondary analyses of the Whiteley Index score revealed that fluoxetine was significantly more effective than placebo and was associated with a significantly faster rate of improvement over 24 weeks. Compared with placebo, patients receiving fluoxetine also had significantly lower anxiety scores and higher quality of life scores. There were no significant differences between treatment-emergent adverse events or dropout rates across the groups. 

“The improvement with fluoxetine could not be accounted for by improvement in depression alone, as the difference in depression scores over time was not significant. This suggests that pharmacotherapy had a relatively specific effect on hypochondriacal symptoms,” Fallon and colleagues wrote. “The continuous measures analyses of the hypochondriasis measures support the conclusion that fluoxetine was the primary treatment contributing to improvement.”

Fallon said more research is needed to understand why participants receiving the combination of fluoxetine and CBT experienced only an incremental benefit over those receiving one treatment or the other. Additional CBT sessions with an added exposure therapy component may improve the results of the joint treatment, he said.

This research was supported by grants from the National Institute of Mental Health. ■