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| |  Clomipramine More Effective Than Desipramine For Body Dysmorphic Disorder LOS ANGELES, CA -- October 26, 1999 -- The drug clomipramine is more effective than desipramine in the treatment of body dysmorphic disorder (BDD), a disorder in which a person is preoccupied with an imagined or slight defect in their appearance. These results are presented in an article in the November issue of the Archives of General Psychiatry, a member of the JAMA family of journals. Eric Hollander, M.D., and colleagues from the Mount Sinai School of Medicine, in New York, randomized 29 patients to initially receive either clomipramine or desipramine for treatment of BDD for the first eight weeks of the drug trial. The participants then "crossed over" to use whichever drug they had not yet used for the remaining eight weeks of the trial. The trial was double-blinded (neither the participants nor the psychiatrists and psychologists who evaluated the participants were aware of which treatment the participants were receiving). Dr. Hollander presented the results of the study today at the American Medical Association’s 18th Annual Science Reporters Conference at the University of California at Los Angeles. The researchers found that clomipramine, a serotonin reuptake inhibitor, was significantly more effective than desipramine, a norepinephrine reuptake inhibitor, in reducing the patient’s obsessive preoccupation with perceived body defects and their repetitive behaviors in response to this preoccupation as well as reducing overall BDD symptom severity. The researchers also found that clomipramine was more effective than desipramine in improving functional disability. For people with BDD, the most common perceived flaws in appearance are facial, but persons with BDD may also have a preoccupation with other body parts. Citing other research the authors note: "BDD results in severe distress, impairment in social and occupational functioning and high rates of hospitalization, suicidal ideation and suicide attempts. ... Attempting to examine, mask or change their appearance, patients perform compulsive/repetitive behaviors such as frequent mirror checking, excessive grooming or skin picking. Up to 50 percent of patients with BDD turn to surgical procedures in futile attempts to correct perceived defects." The authors note that BDD shares similar features with obsessive-compulsive disorder (OCD), especially obsessive and intrusive thoughts and compulsive and repetitive behaviors, as well as the age range in which the disorder typically begins (during the teenage years). They add that other studies have indicated that up to 12 percent of psychiatric outpatients may have BDD. "The positive findings of this first controlled study in BDD are a significant initial step in establishing the efficacy of clomipramine in the treatment of this debilitating disorder, even among delusional patients," the authors write. The effect of the treatments was independent of the presence or severity of other coexisting psychological disorders, such as OCD, depression or social phobia, according to the authors. The researchers also studied whether there was a difference between patients with BDD who were delusional and those that were not. "Fixity [how strongly held the beliefs were by the patient] of BDD beliefs did not limit treatment outcome; while receiving clomipramine delusional patients improved at least as much as nondelusional patients and perhaps more," the authors write. "This is of clinical importance, suggesting that delusional patients may not require neuroleptic treatment [treatments used to treat psychosis] and thus might be spared possible adverse effects associated with long-term neuroleptic use." This study was supported in part by grants from the Food and Drug Administration, Washington, D.C., the Seaver Foundation, New York, and the National Institutes of Health, Bethesda, Md., to the Mount Sinai Clinical Research Center. While clomipramine and desipramine are both tricyclic antidepressants, they afect the central nervous system differently. Clomipramine is a serotonin reuptake inhibitor and desipramine is a selective norepinephrine reuptake inhibitor.
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