Medications For BDD

If BDD is about body image, why do I need medication?

Well medications can actually help with body image. Medications in addition help with depression and anxiety that go along with BDD. But what happens when people get treated with medications is they often can develop an improved insight that this is a psychiatric problem, that the things they think are defective maybe aren't exactly the way they thought they were. How they feel about their appearance can change from the medication.

What medications are prescribed for BDD?

Medications that are commonly prescribed for BDD that seem to be effective are the serotonin reuptake inhibitors. These are medications like: Prozac ,Paxil, Zoloft, Celexa. The medications also need to be at a dose that's sufficient. So, usually two or three times the dose that somebody takes for depression, people need to take for BDD.

How well do medications work at treating BDD?

There have actually been controlled studies looking at what medications are effective in treating BDD and proving that the serotonin reuptake inhibitors are effective medicines in treating BDD. There has been a study looking at Prozac and in this study they compared Prozac with placebo. It was a controlled study and they saw that Prozac significantly improved symptoms over placebo in BDD. There has also been another controlled study comparing a medication that effects serotonin called clominpramine with one that is an antidepressant but doesn't effect seratonin called desipramine. The one that affects serotonin clearly was effective while the other one wasn't.

How do SRI medications change the brain chemistry of those with BDD?

Dr. Jaime Feusner: Well in BDD, the medications are really treating several different components of the problem. So, because almost everybody has some degree of depression, usually has some degree of anxiety as well as the actual BDD symptoms like concern about appearance that it probably affects all of those and that's how somebody gets better. How it effects the BDD specifically is that it may decrease the intrusiveness of their thoughts and the possessiveness of their thoughts and we are not exactly sure how that does it although we do know that serotonin has an inhibitory effect on certain brain regions and so the medications do increase the serotonin transmission which probably is dampening down areas that are hyperactive and part of the problem

In what ways do SRI medications improve life for people with BDD?

The SRI medications can really help BDD in a lot of ways. And one of them is, it can help so that the depression is not so severe and most likely take away the depression. So that if even they're still concerned about something about their appearance, they don't go down into the same downward spiral and feel worse and have disfunction because they are so depressed. Also, it usually allows them to be able to be out in public and not be so self conscious. It usually helps them develop a little bit better insight that this is a psychiatric problem and not so much an appearance problem. And then usually they're able to kind of get rid of the thoughts a little bit easier and not think about these all day long.

How long does it take for an SRI to improve things for someone with BDD?

There is usually a delay. So you start taking the medication, your not going to get better right away. It's not something that you get better the first few days. Usually people have to wait several weeks. Sometimes between six and twelve weeks before they may actually start noticing the benefits. But hopefully they'll start feeling better in terms of depression within a couple of weeks of taking it.

Do SRI's work for everyone with BDD?

SRI's work for most people with BDD. There are some people that may not respond very well to SRI's, and in that case there are other medications that can be used to try to help them. Other medications we know a lot less about in terms of there being controlled studies, but in terms of clinical experience, other medications that may effect norepinephrine as well as serotonin might be effective in some people. For other people they may benefit from having medication added to the serotonin reuptake inhibitor if it's only working a little bit.

What are the risks of SRI or antidepressant medications?

So antidepressant medications can have some side effects and the side effects usually happen in the beginning of treating. So the first few days people can experience some upset stomach, or they might have a little bit of insomnia, a little bit of jitteriness, a little bit of sedation. Those usually go away after somebody has been on it for a little while. Other risks are sexual side effects, are unfortunately fairly common for these medications. And there are some risks of people actually getting worse in some cases especially if they have an underlying undiagnosed bipolar disorder.

Can MAO inhibitors work on BDD?

MAO inhibitors can sometimes work in BDD but they haven't really been studied thoroughly. And so we don't know, in a large population of people with BDD, are they more effective than placebo? Are they more effective than other medications? They're just anecdotally, in terms of clinical experience, that some people that maybe don't respond to other medications might respond to an MAO inhibitor.

Can anti-anxiety medications be combined with antidepressants to treat BDD?

Yes. Anti-anxiety medications can sometimes be combined with antidepressants, especially if somebody has very, very severe anxiety and they really need some quicker symptom relief. And because the serotonin reuptake inhibitors usually take several weeks to start working, in the beginning somebody might benefit from maybe a couple of week treatment with anti-anxiety medications to help get them through to when the other medication starts kicking in.

When is an antipsychotic needed to treat BDD?

Antipsychotic medications can sometimes be helpful in BDD. Again, there's not as much controlled data supporting it yet. But in some cases, I think--especially where there are very severe symptoms, a lot of delusionality, and maybe very acute symptoms that the person is suicidal, and they need relief right away--that there's a role for antipsychotics for them.

How long do I have to take medication if I have BDD?

Well that's a good question, how long should somebody take medication if they have BDD? We don't really know the answer to that and somebody is actually studying that question as we speak, but what is probably a good rule of thumb is to think about being on the medication for, the very least for a year or two, and that's a year or two of feeling better because you really need to kind of get your life back together and you need to start functioning again, you need to kind of get in the swing of things with work, relationships, and whether it be these symptoms come back after you go off medication, you know, we don't know, we're trying to figure that out, but for a lot of people those symptoms do come back after they go off the medications. It may be less likely to happen if you have therapy with it. There's some people that they keep having the symptoms come back every time they go off the medication, and in those people it is probably better for them to stay on the medication to prevent these relapses, and there may be some other people that can come off medication successfully.