The pharmacotherapy of hypochondriasis

Abstract

This article addresses the diagnosis and pharmacologic treatment of hypochondriasis. Diagnostic issues are reviewed briefly, focusing on the need for a thorough medical re-consideration of the patient's presenting symptoms. Because the diagnosis rests on the absence of a medical cause to account for the presence or intensity of the physical symptoms, neither self-report forms nor non-medically trained interviewers should be used to definitively make the diagnosis of hypochondriasis. We review the case reports and small uncontrolled series on the pharmacologic treatment of hypochondriasis, emphasizing the growing body of evidence suggesting particular efficacy for the serotonin reuptake inhibitors. Preliminary results from an ongoing placebo-controlled trial of hypochondriasis using fluoxetine are presented. While the controlled trial supports the open treatment data in revealing a high rate of improvement among patients completing treatment with fluoxetine, it also demonstrates that many patients respond to placebo as well. In conclusion, although the traditional nihilistic attitude regarding the possibility of successful treatment of hypochondriacs appears no longer warranted, the question remains open as to whether SSRIs have particular efficacy in patients with hypochondriasis or whether nonspecific treatment effects are the primary cause of improvement.