Risperidone Augmentation in Antidepressant-Resistant Somatic Symptom Disorder

Chronic somatic symptoms are hallmarks of somatic symptom disorder (SSD), characterized by notable disruptions in the day to day lives of affected patients. Risperidone is an effective augmenting agent for treatment-resistant major depressive and obsessive-compulsive disorders. Although various antidepressants have been used for the pharmacotherapy of SSDs, no guidelines have been formulated for treatment-resistant or severe SSDs. To date, the efficacy of risperidone augmentation for the treatment of antidepressant-resistant SSD has not been reported. Here, we report the case of a 68-year-old female patient with SSD and comorbid persistent depressive disorder. Upon admission, laboratory tests revealed no abnormalities except for a high triglyceride level. Psychosocial functioning and depressive symptoms were evaluated using the Global Assessment of Functioning and Beck Depression Inventory II. The severe and persistent symptoms of the patient were remarkably alleviated following low-dose risperidone augmentation with mirtazapine combined with desvenlafaxine. Furthermore, notable therapeutic effect of risperidone augmentation was observed following a significant reduction in the subjective distress of the patient and functional recovery within a short period. Our report suggests that early augmentation with risperidone facilitates the analgesic effect of serotonergic/noradrenergic antidepressants and contributes significantly to the rapid amelioration of SSD severity.