Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T04:19:20.307Z Has data issue: false hasContentIssue false

Psychopharmacotherapy of somatoform disorders: effects of opipramol on symptoms of somatization, anxiety, and depression

Published online by Cambridge University Press:  24 June 2014

Hans-Jürgen Möller*
Affiliation:
Ludwig-Maximilians-University, Munich, Germany
Hans-Peter Volz
Affiliation:
Hospital for Psychiatry and Psychotherapy, Schloss Werneck, Germany
Klaus-Dieter Stoll
Affiliation:
Novartis Pharma, Nuremberg, Germany
*
H.-J. Möller, Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstrasse 7, 80336 Munich, Germany. Tel: 00 49 8951605501; Fax: 00 49 8951605522; E-mail: [email protected]

Abstract

Background:

The psychopharmacotherapy of somatoform disorders (SD; ICD-10: F45) has been less frequently investigated and is not as well established as in other (neurotic) disorders of ICD-10 section F4, i.e. generalized anxiety disorder (GAD; ICD-10: F41.1). The atypical compound opipramol is very often used to treat SD and GAD in clinical practice in Germany. However, state-of-the-art controlled clinical trials have not yet been performed.

Objectives:

Two clinical trials were performed with the aim of confirming the efficacy and tolerability of opipramol in SD and GAD.

Methods:

Both trials were performed as randomized, double-blind, placebo-controlled, multicenter studies. While the GAD trial was a three-arm study with opipramol (200 mg/day) vs. placebo and alprazolam (2 mg/day) for 28 days, the SD trial was a placebo-controlled two-arm study with a treatment duration of 42 days. Each group consisted of about 100 patients.

Results:

Significant differences (alpha = 0.05) were found for the primary efficacy criteria (HAMA total score in GAD, HAMA somatic subscore in SD) and most of the secondary criteria in favor of the active drug therapies. Considerable differences between the psychopathology of SD and GAD were detected.

Conclusion:

The well-tolerated anxiolytic opipramol is the first psychotropic drug with proven efficacy in somatoform disorders with effects on symptoms of somatization, anxiety, and depression. The compound is also effective and safe in GAD.

Type
Research Article
Copyright
Copyright © 2003 Blackwell Munksgaard

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Volz, HP, Stieglitz, RD, Menges, K, Möller, HJ. Somatoform disorders – diagnostic concept, controlled clinical trials, and methodological issues. Pharmacopsychiatry, 1994;27: 231237.CrossRefGoogle ScholarPubMed
Briquet, P. Traité Clinique et Therapeutique de l'Hystéria. Paris: Ballière et fils, 1859. Google Scholar
Adjan, M. Behandlung von funktionellen Herz- Kreislauf-Beschwerden mit dem trizyklischen Psychopharmakon Opipramol. Med Welt 1987;38: 147150. Google Scholar
Stroband, T. Opipramol bei funktionellen Organbeschwerden unter besonderer Berücksichtigung von gastrointestinalen Störungen. Medwelt 1988;39: 14871490. Google Scholar
Rao, TS, Cler, JA, Mick, SJet al. Neurochemical characterization of dopaminergic effects of opipramol, a potent sigma receptor ligand in vivo. Neuropharmacology 1990;29: 11991204.CrossRefGoogle ScholarPubMed
Volz, HP, Möller, HJ, Reimann, I, Stoll, KD. Opipramol for the treatment of somatoform disorders, results of a placebo-controlled trial. Eur Neuropsychopharmacol 2000;10: 211217.CrossRefGoogle ScholarPubMed
Möller, HJ, Volz, HP, Reimann, I, Stoll, KD. Opipramol for the treatment of generalized anxiety disorder. A placebo-controlled trial including an alprazolam treated group. J Clin Psychopharmacol, 2001;21: 5965.CrossRefGoogle ScholarPubMed
Müller, WE, Siebert, B. Opipramol im Vergleich zu anderen Therapeutika – Neue pharmakologische Daten. Fortschritte der Neurologie – Psychiatrie 1998;66: S9S12. CrossRefGoogle Scholar
Theobald, W, Büch, O, Morpurgo, C, Stenger, EG, Kunz, HA, Wilhelmi, G. Vergleichende pharmakologische Untersuchungen mit Tofranil, Pertofran und Insidon. Arch Int Pharmacodyn 1964;148: 560596. Google ScholarPubMed
Gentsch, C. Opipramol in verhaltenspharmakologischen Angst- und Depressionsmodellen. Fortschritte der Neurologie – Psychiatrie 1998;66: S17S20. CrossRefGoogle Scholar
Engel, RR. Meta-Analyse der kontrollierten klinischen Prüfungen von Opipramol. In: Müller, WE Möller HJ, eds. Opipramol, Sigmaligand und Stimmungsaufhellendes Anxiolytikum. Neu-Isenburg: LinguaMed-Verlags-GmbH, 2001: 8192. Google Scholar
Jepson, K, Beaumont, G. A comparative trial of opipramol and chlordiazepoxide in the treatment of anxiety. J Int Med Res 1973;1: 145150. CrossRefGoogle Scholar
van Lith, ND, Motké, JCT. Opipramol in the climacteric syndrome. A double-blind, placebo-controlled trial. Maturitas 1983;5: 1723.CrossRefGoogle ScholarPubMed
Johnson, H. Undersökning med Ensidon pa allmänpraktistk neurosklientel. Läkartidningen 1966;63: 30063011. Google Scholar
Franke, GH. Die Symptom-Checklist von Derogatis – Deutsche Version – Manual. Göttingen: Beltz-Test GmbH, 1995. Google Scholar
CIPS (Collegium Internationale Psychiatriae Scalarum). Internationale Skalen für Psychiatrie. Göttingen: Beltz-Test GmbH, 1996. Google Scholar
Rickels, K, Csanalosi, I, Greisman, Pet al. A controlled clinical trial of alprazolam for the treatment of anxiety. Am J Psychiatry 1983;140: 8285.Google ScholarPubMed
Sánchez, G, Amt, J, Costall, Bet al. The selective sigma-2-ligand Lu 28–179 has potent anxiolytic-like effects in rodents. J Pharmacol Exp Therapeutics 1997;283: 13231332. Google Scholar
Pande, AC, Genève, J, Scherrer, B, Smith, F, Leadbetter, RA, de Meynard, C. A placebo-controlled trial of igmesine in the treatment of major depression. Eur Neuropsychopharmacol 1999;9(Suppl. 5):S138. CrossRefGoogle Scholar
Rozé, C, Des Varennes, SB, Shi, G, Genève, J, Galmiche, JP. Inhibition of prostaglandin.induced intestinal secretion by igmesine in healthy volunteers. Gastroenterology 1998;115: 591596.CrossRefGoogle ScholarPubMed
Grabe, HJ, Freyberger, HJ. Anwendungsbeobachtungen mit Opipramol (Insidon) bei somatoformen Störungen. In: Müller, WE, Möller, HJ, eds. Opipramol, Sigmaligand und Stimmungsaufhellendes Anxiolytikum. Neu-Isenburg: LinguaMed-Verlags-GmbH, 2001: 127135. Google Scholar