Currently, SRIs are recommended as the first-line Wortmannin price medication for BDD, including delusional BDD.1,26,104,105 Two controlled studies, four open-label trials, and clinical series have reported on SRI efficacy for BDD. All studies found that these medications are often efficacious for BDD.106-110 In a randomized double-blind parallel-group study, fluoxetine was more efficacious than placebo (d=.70).111 In a randomized, double-blind

crossover trial, the SRI clomipramine was more efficacious than the non-SRI antidepressant desipramine.106 Four open-label trials (of fluvoxamine, citalopram, and escitalopram), retrospective Inhibitors,research,lifescience,medical studies of a broad range of SRIs, and case series similarly suggest that SRIs are often efficacious for BDD and associated symptoms.7,107-109,112-115 SRI antidepressants appear more efficacious for BDD than non-SRI antidepressants or other types of psychotropic medication, although data are limited.26 Relatively high SRI doses appear to often be needed, and current recommendations Inhibitors,research,lifescience,medical are that the SRI should be taken for at least 12 weeks before determining Inhibitors,research,lifescience,medical whether it is efficacious.1,26 At that time, if it is not

helpful, the SRI should be augmented with another medication, or the SRI should be switched to a different SRI.1,115 Successful SRI treatment results in less frequent and intense appearance preoccupations, decreased BDDrelated distress, Inhibitors,research,lifescience,medical less intense urges and less time spent performing compulsive/safety behaviors, and better control over BDD preoccupations and compulsions.26 Most studies have found that associated symptoms, such as depressive symptoms, functioning, and quality of life, often improve as well.26,116 In addition,

most studies have found that insight regarding the perceived appearance flaws improves with SRI treatment.26 Little data are available on the efficacy of antipsychotic medications for BDD, even though many patients have delusional BDD beliefs. Several case reports indicate Inhibitors,research,lifescience,medical successful SRI augmentation with an antipsychotic.117,118 However, a study that examined the efficacy secondly of augmenting fluoxetine with pimozide versus placebo found that pimozide augmentation was not more efficacious than placebo augmentation.119 The sample size was small (n=28), raising the possibility of Type II error. However, the effect size was small (d=0.23), and only 18.2% of subjects responded to pimozide (versus 17.6% to placebo), suggesting minimal efficacy for pimozide augmentation. In a small case series of olanzapine augmentation of fluoxetine, BDD symptoms were minimally improved in 2 of 6 patients, and no patient experienced more substantial improvement, suggesting that atypical neuroleptics may not be efficacious for BDD.120 Other augmentation strategies have been preliminarily examined, with data suggesting that buspirone, and occasionally other medications, may be helpful when added to an SRI.