Paroxetine and naloxone displayed modest efficacy in the treatment of comorbid depersonalization and dissociative symptoms associated with posttraumatic stress disorder (PTSD) and borderline personality disorder, according to study data published in Psychiatry Research. Overall effect estimates favored pharmacotherapy over placebo, although limited data were available for the effects of pharmacotherapy on specific dissociative disorder subtypes.
Investigators conducted a systematic review of Medline, PubMed, and Google Scholar for studies of pharmacotherapy for dissociative disorders. Studies published in English between 1967 and 2019 were eligible for inclusion in the review. Quantitative and qualitative syntheses were performed to summarize findings. Response to pharmacotherapy was measured in terms of score reductions on the Dissociative Experience Scale, the Cambridge Dissociation Scale, and other subjective patient- and clinician-reported measures. The efficacy of each pharmacotherapy modality vs placebo was expressed as a risk ratio (RR).
The literature search identified 1028 eligible studies; 7 randomized placebo-controlled trials were selected for review. The pooled study cohort comprised 214 patients between age 18 and 45 years. Per quantitative analysis, treatment response in the pharmacotherapy group (n=95) was significantly higher than in the control group (n=119) (RR, 1.59; 95% CI, 0.76-3.30; P =.21). However, high heterogeneity existed among the studies (P <.00001). In subgroup analyses, modest evidence was observed for paroxetine in reducing dissociative symptoms in PTSD (RR, 2.44; 95% CI, 1.16-5.16). Of the studies, 2 indicated modest efficacy of naloxone in reducing depersonalization symptoms over placebo. However, these specific studies had significantly different patient cohorts: one enrolled patients with depersonalization disorder and the other studied acute dissociative states in borderline personality disorder. Thus, the effect of naloxone on dissociative disorders in general could not be extrapolated.
While these analyses provide some evidence for the efficacy of fluoxetine and naloxone in treating depersonalization symptoms, limited data and high between-study heterogeneity restrict the generalizability of the results. Many subtypes of dissociative disorder were also omitted from analysis given the lack of relevant publications; further research on specific disorder subtypes is needed to identify effective pharmacotherapy. Additional research is also necessary to build on the evidence supporting paroxetine and naloxone as treatment for dissociative symptoms.
Sutar R, Sahu S. Pharmacotherapy for dissociative disorders: a systematic review [published online August 23, 2019]. Psychiatry Res. doi:10.1016/j.psychres.2019.112529