CBT-fluoxetine combo therapy outperforms single treatment for hypochondriasis
A recent study has shown the safety, efficacy and tolerance of fluoxetine for hypochondriasis. Moreover, joint treatment with both fluoxetine and cognitive behavioural therapy (CBT) confers a small incremental benefit over a single active treatment.
To determine whether joint treatment provides additional benefit, researchers randomized 195 patients with DSM-IV hypochondriasis to one of four treatments: placebo, CBT, fluoxetine, or joint treatment with fluoxetine and CBT. Analyses focused on hypochondriasis, adverse events, quality of life, functional status and other psychopathology.
At week 24, outcome was assessed among the intent-to-treat patients, with responders defined as having a ≥25-percent improvement over baseline on both the Whiteley Index and a modified version of the Yale-Brown Obsessive Compulsive Scale for hypochondriasis (H-YBOCS-M).
The Cochran-Armitage trend test assessed the hypothesized pattern of response: joint treatment > CBT or fluoxetine treatment > placebo treatment.
There was a statistically significant predicted pattern of response as shown by the following responder rates: joint treatment group, 47.2 percent; single active treatment group, 41.8 percent; and placebo group, 29.6 percent. There was no significant difference between responder rates for each active treatment and the rate for placebo.
Based on secondary analyses of the Whiteley Index as a continuous measure, fluoxetine was more effective at week 24 in reducing hypochondriasis and had a significantly faster rate of improvement over 24 weeks than placebo. Fluoxetine also led to significantly less anxiety and better quality of life compared with placebo.
Dropout rates were not different between groups. In addition, there was an even distribution of treatment-emergent adverse events.
According to researchers, “[b]ecause approximately 50 percent of patients did not respond to the study treatments, new or more intensive approaches are needed.”