What is Hypochondriasis?
Although hypochondriasis shares some of the characteristics of obsessive compulsive disorder, it is actually classified as a somatoform disorder in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Patients with a somatoform disorder claim they are experiencing physical symptoms that cannot be explained by an existing medical condition, substance use or abuse, or other mental disorder.
Overly preoccupied with their normal body functions and sensations, hypochondriacs will convince themselves that these normal functions or a slight irregularity with them are signs of a life-threatening disease. To a hypochondriac, excessive sweating may be a sign of diabetes or a thyroid condition and a minor headache a brain tumor.
Similar to OCD, hypochondriacs cannot control these ideas and will compulsively seek medical attention to diagnose their self- perceived condition, which often results in much distress for the sufferer and interferes with their ability to function on a daily basis. Also, reassurance by physicians that no illness exists generally leads to increased anxiety on the part of the hypochondriac.
Types of Hypochondriasis Medications
The recommended treatment for hypochondriasis is cognitive behavioral therapy (CBT); however there are medications that can be used in conjunction with CBT to help reduce the anxiety and perceived physical symptoms associated with hypochondriasis, especially if there are comorbid mental disorders. Approximately 75 to 85 percent of those who suffer from hypochondriasis have a comorbid mental disorder such as anxiety, depression, or OCD. Hypochondriasis medications used alone have not proven to be effective in treating the disorder. There are four classes of medications that are generally prescribed – antidepressants, beta-adrenergic receptor-blocking agents, benzodiazepines, and antipsychotic medications.
Antidepressants (SSRIs, TCAs, and SNRIs)
Antidepressants are the most commonly prescribed medication for hypochondriasis, especially if there is comorbidity with other mental disorders. Selective serotonin reuptake inhibitors (SSRIs) tend to be the most effective in treating the symptoms associated with hypochondriasis and have fewer side effects than other antidepressants.
SSRIs alleviate the symptoms of depression by altering the neurotransmitters, which are chemical messengers that the brain uses to communicate between its cells. SSRIs block the reabsorption – known as reuptake – of serotonin, a neurotransmitter in the brain that affects mood. Adjustments in serotonin levels appear to help brain cells send and receive chemical messages more efficiently, which can lead to improved mood. SSRIs appear to only have an effect on serotonin, and not other neurotransmitters, which is why they are called selective. Commonly prescribed SSRIs for hypochondriasis include:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
Serotonin norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs, but affect two neurotransmitters – serotonin and norepinephrine. Norepinephrine helps control how the body responds to stress by regulating heart rate, blood pressure and sugar levels. Low levels of norepinephrine can suppress normal mental and emotional functions, leading to depression-like symptoms. SNRIs are reported to be more effective than SSRIs in treating symptoms, but the side effects can be more severe. Venlafaxine (Effexor XR) is the most often prescribed SNRI for treating hypochondriasis.
Tricyclic antidepressants (TCAs) such as clomipramine (Anafranil) and imipramine (Tofranil), also affect serotonin and norepinephrine, but they have considerably more side effects than SSRIs and SNRIs because they affect other neurotransmitters in the brain. They are recommended for use if other antidepressants fail to relieve the patient’s symptoms.
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Beta-Adrenergic Receptor-Blocking Agents (Beta Blockers)
Although beta blockers are typically used to treat heart conditions, high blood pressure and migraines, they can also be used to manage the physical symptoms of anxiety such as trembling, shaking or sweating. Propranolol (Inderal) can be used on a short-term basis to control these symptoms.
Benzodiazepines (Anti-Anxiety Medications)
Benzodiazepines or anti-anxiety medications act as a central nervous system (CNS) depressant, meaning they reduce the symptoms of anxiety by impeding the central nervous system and diminishing some brain activities. Alprazolam (Xanax) is very effective at controlling the panic attacks and other anxieties that plague hypochondriacs. However, all anti-anxiety medications, including alprazolam, should be taken with caution and for a short duration as tolerance is a common side effect that can lead to an increased possibility of substance abuse and/or dependence.
In addition, even low dosages can cause side effects such as extreme sleepiness, fogginess, and clumsiness that can became substantially worse if the drugs are taken for long periods of time or if the dosages are increased. This is because anti-anxiety medications tend to metabolize slowly and build up in the body.
Antipsychotic medications, such as Risperidone (Risperdal), Olanzapine (Zyprexa) and/or Pimozide (Orap), should only be prescribed by a psychiatrist if the symptoms of hypochondriasis are due to a psychotic disorder, especially if there is evidence of comorbid anxiety, obsession with their symptoms or delusional thinking and/or behaviors. Also, the side effects of antipsychotics often preclude their benefits unless there is an underlying psychotic disorder causing the hypochondriasis.
NB: The content of this article is for information purposes and is not intended to replace sound medical advice and opinion.
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