Pharmacotherapy for dissociative disorders: A systematic review

Area of Science:

• Psychiatry
• Clinical Psychology
• Pharmacology

Background:

• Dissociative disorders (DD) encompass a range of conditions with shared psychopathology.
• Evidence supporting psychopharmacological treatments for DD is limited, with various agents used without conclusive results.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) on pharmacotherapy for dissociative disorders.
• To evaluate the efficacy of pharmacological interventions in reducing dissociative symptoms.

Main Methods:

• A systematic review adhering to PRISMA guidelines was conducted.
• Data from 5 RCTs involving 214 participants, published between 1967 and 2019, were analyzed.
• The review protocol was registered under PROSPERO (Study ID CRD42019127235).

Main Results:

• Pharmacotherapy demonstrated a significantly higher treatment response rate (68.42%) compared to the control group (39.49%).
• The pooled relative risk (RR) favored pharmacotherapy, although not statistically significant (RR = 1.59, P = 0.21).
• Overall effect estimates suggest a favorable outcome for pharmacotherapy over placebo.

Conclusions:

• Paroxetine and Naloxone are the only agents with modest evidence from RCTs for specific dissociative symptoms, particularly depersonalization.
• These findings are relevant for dissociative symptoms comorbid with PTSD and BPD.
• Results should be interpreted cautiously due to high heterogeneity and limited RCT literature across DD subtypes.