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Cognitive behavioral therapy plus fluoxetine more beneficial for hypochondriasis

Recent findings indicated fluoxetine was effective for hypochondriasis and joint treatment with cognitive behavioral therapy and fluoxetine added a small benefit.

“Cognitive behavioral therapy (CBT) has been shown to reduce hypochondriacal symptoms, with effect sizes ranging from small to large. Other psychotherapies or adaptations of CBT are also beneficial in hypochondriasis, including exposure therapy, mindfulness-based CBT, acceptance and commitment therapy, attention training, and Internet-based CBT,” Brian A. Fallon, MD, of New York State Psychiatric Institute, and colleagues wrote. “The literature on the efficacy of pharmacotherapy is more limited.”

To determine if combined CBT and medication treatment offered additional benefit for hypochondriasis, researchers conducted a randomized controlled trial among 195 individuals with DSM-IV hypochondriasis. Study participants were randomly assigned to receive CBT, fluoxetine, fluoxetine and CBT, or placebo.

Rates of response were 47.2% in the joint treatment group, 41.8% in the single active treatment group, and 29.6% in the placebo group.

Responder rates in treatment groups did not significantly differ from that in the placebo group.

Secondary analyses that used the Whiteley Index as a continuous measure indicated fluoxetine, but not CBT, was significantly more effective for reducing hypochondriasis at week 24 and had a significantly faster improvement rate over 24 weeks, compared with placebo.

Participants who received fluoxetine reported significantly less anxiety and better quality of life, compared with placebo.

Dropout rates and treatment-emergent adverse events were comparable among treatment groups.

“This study provides further evidence supporting the safety, tolerance and efficacy of fluoxetine for hypochondriasis. However, this study also demonstrates that approximately 50% of patients continue to suffer with substantial hypochondriasis despite treatment, highlighting the limitations of both the pharmacologic and the cognitive behavioral approaches used in this trial,” the researchers wrote. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.