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  • The Body Dysmorphic Disorder Program at Rhode Island Hospital

  • Common Questions About Medications Used to Treat Body Dysmorphic Disorder

  • What are SRIs?
    SRIs (serotonin-reuptake inhibitors), also known as SSRIs, are the first-choice medication for body dysmorphic disorder (BDD). They're the best-studied medication for BDD. Research done by our program and others indicates that a majority of people with BDD improve if they take these medications correctly.

    SRIs are antidepressant medications that also diminish obsessional thinking and compulsive behaviors. This includes less frequent obsessions, decreased urges to perform compulsive behaviors (such as mirror checking and skin picking), and better control over BDD obsessions and compulsions. Distress over the perceived appearance flaws also usually improves. Many other problematic thoughts and behaviors may improve as well, including depression and suicidal thinking.

    Seven SRIs are currently available in the U.S.: escitalopram (Lexapro), citalopram (Celexa), fluvoxamine (Luvox), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and clomipramine (Anafranil).

    Shouldn't I be able to feel better about myself without taking medication?
    Some people want to get better on their own, without medication. Being motivated to get better is very important, but it isn't realistic to try to recover from BDD, especially more severe BDD, solely on your own. BDD is a serious illness. It isn't vanity, and it doesn't reflect moral weakness or weakness of character.

    BDD needs to be treated with approaches that have been shown to work (an SRI or cognitive behavioral therapy). You and the medication work "hand-in-hand" and are on the same team. The right medicine can make it easier for you to make positive changes in your life.

    How does an SRI work?
    Body dysmorphic disorder (BDD) is an illness in which factors such as genetics, chemical changes in the body, and external events may play an important role. Research suggests that BDD may be linked to changes in brain circuits and the functioning of brain chemicals called neurotransmitters. These complex biological changes can produce profound changes in the way you view yourself and your behavior. SRIs appear to correct these problems. They promote healthy functioning of brain circuits and the natural brain chemical serotonin.

    Do SRIs cause side effects?
    SRIs are generally well tolerated. Many people have no side effects; when they occur, they're usually tolerable and may resolve simply with the passage of time. Side effects that don't resolve with time can sometimes be minimized or avoided by changing the dose, the timing of doses, or other strategies. It's important for you and your treating clinician to work collaboratively to try to minimize side effects if they occur.

    Is the medication addictive? Will I get "high"?
    SRIs are not addictive, and you won't get "high" from them. Some people experience transient symptoms when an SRI is discontinued (especially if it's discontinued abruptly), but these symptoms don't reflect an addiction to the medication.

    Will the medication change my personality?
    Some people worry that taking an SRI will make them behave abnormally or look like a zombie. While occasional patients feeling tired or agitated while taking an SRI, they act normally and don't look as though they're "drugged." Patients who get better on an SRI usually say they feel more normal, or that they feel more like themselves again.

    I heard something about SRIs and suicide. Is there a connection?
    While some studies suggest that, rarely, people who take an SRI may have increased thoughts about death or suicide, or even attempt suicide, other studies have found that SRIs may decrease suicidal thinking or attempts. There is no evidence whatsoever that these medicines make people actually kill themselves. In fact, in BDD, research shows that suicidal thinking typically improves significantly when people are correctly treated with an SRI. However, all people with BDD - whether or not they're taking an SRI -- need to be carefully monitored for suicidal thinking and behavior.

    How will SRIs affect my brain?
    When they work, SRIs have positive effects on people's brain. They correct a "chemical imbalance" in the brain and promote the healthy functioning of the natural brain chemical serotonin. There's no evidence that psychiatric medicines such as SRIs will harm your brain. In fact, they appear to make the brain healthier by protecting brain cells from damage or death, and by stimulating the healthy growth of new brain cells.

    When it comes to other parts of your body, such as your heart, patients treated with SRIs have a lower rate of heart attacks and death from heart disease than those who don't take an SRI.

    How long will it be before I feel better?
    It may take anywhere from two weeks to three months or so before SRIs start to have any effect on BDD symptoms, and they may not reach their maximum effect for several more weeks or months.

    I've taken an SRI before and I didn't get better. Why should I try another?

    There are a few reasons this might have happened:

    1. You might not have taken a high enough dose of the SRI, and didn't get better for this reason.
    2. You might have stopped the medicine before it had enough time to take effect. It's important to take the SRI every day for 3 to 4 months to see if it will work.
    3. The medication needs to be taken as prescribed - it won't work effectively if it isn't taken every day or if less is taken than prescribed.
    4. People can respond differently to different SRI. Perhaps the one you tried before wasn't a good match for you. Many people who don't get better with one SRI - even if they've given it an adequate try-will get better with a different SRI. So it's definitely worth trying another one.