Venlafaxine - Induced Orthostatic Hypotension

facets. BDD, whether delusional or nondelusional, responds to antidepressants, particularly SRIs. A recent double-blind trial comparing clomipramine with desipramine demonstrated the efficacy of the former irrespective of whether the patients had insight or held their dysmorphic perception with delusional intensity (Hollander etal., 1999). Moreover, there are reports of cases resistant to pimozide, the traditional choice for delusional BDD, subsequently responding to SRIs, which also happened in this patient (Wada et al., 1999). Thus the emerging consensus is that SRIs may be considered as first line agents in the treatment of BDD (Phillips etal., 1998; Hollander etal., 1999). An intriguing observation in our case was the non-response to one SRI and a subsequent response to another. Such a preferential response to one SRI over another has been cited before (Dominguez & Puig, 1997). Hence, a failed trial of one SRI should not deter a clinician from trying a second SRI. Augmenting with buspirone represents another alternative. Finally, another finding of significant clinical importance is that the presence of obsessive-compulsive symptoms, syndromal or otherwise, in BDD are not a prerequisite for response to SRIs considering that these agents have additional anti-obsessive properties and that BDD is an obsessivecompulsive spectrum disorder (Hollander et al., 1999). This too was adequately demonstrated by this report.