Pharmacotherapy for dissociative disorders: A systematic review

• Published in: Psychiatry research Vol. 281; p. 112529
• Main Authors: Sutar, Roshan, Sahu, Sandhaya
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.11.2019
• Subjects: Dissociative disorders; Dissociative Disorders - drug therapy; Female; Humans; Male; Naloxone - therapeutic use; Paroxetine - therapeutic use; Pharmacotherapy; Placebo; Psychotropic Drugs - therapeutic use; Randomized Controlled Trials as Topic; Systematic review; Treatment Outcome; Pharmacotherapy; Systematic review; Dissociative disorders; Placebo
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2019.112529

•There is sparse evidence for the use of specific psychopharmacological agent in the treatment of dissociative disorders.•The treatment response rate of pharmacotherapy group is significantly higher than placebo for Lamotrigine, Paroxetine and Naloxone while negative for Fluoxetine and Naltrexone.•The limited availability of isolated treatment trials for dissociative disorders makes is difficult to comment on utility of any single agent in treatment of dissociative disorders.•Current evidence suggests the need for systematic placebo controlled RCTs for the treatment of dissociative disorders. Dissociative Disorder (DD) is a large group of disorders that shares common psychopathology. Psychopharmacological agents have sparse evidence in the treatment of DD in general. Multiple pharmacotherapy options have been used without conclusive evidence. We conducted a systematic review of data in English language from 1967 to 2019 the protocol of which was registered under PROSPERO (Study ID CRD42019127235). Using PRISMA guidelines, 5 RCTs reporting data on 214 participants providing data on response to pharmacotherapy in dissociative disorder were included. The treatment response rate of pharmacotherapy group as measured in reduction in dissociative symptoms was 68.42% (n = 65/95), significantly higher than that of 39.49% (n = 47/119) in the control group. And, the pooled RR was 1.59 (95% CI, 0.76–3.30; P = 0.21). The overall effect estimates are favourable to pharmacotherapy group over placebo. It would be apt to conclude that Paroxetine and Naloxone are the only pharmacological agents studied through RCTs and found to have modest evidence for controlling depersonalization symptoms and dissociative symptoms that are comorbid with PTSD and BPD. Results of this meta-analysis should be interpreted with caution in view of high heterogeneity and scanty literature on RCTs on various subtypes of DD.