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SIADH Caused by Paroxetine

erally display high levels of anxiety, depression, and affective instability, adequate pharmacotherapy for the core target symptom of dissociation is elusive. Coexisting diagnoses such as posttraumatic stress disorder (PTSD), borderline personality disorder, major depression, anxiety, and substance abuse contribute to the heterogeneous presentation of DID. Pharmacologic amelioration of comorbid symptoms can potentially confound outcome analyses and impose significant limitations on the generalizability of such data. Current DID treatment approaches incorporating pharmacotherapy are based primarily on anecdotal uncontrolled observations, often resulting in complex medication regimens. Extant concerns relate to polypharmacy and its consequences. Most patients are either diagnosed with PTSD or manifest symptoms consistent with posttraumatic stress, including nightmares, flashbacks, and startle responses.3 Since DID is believed to be posttraumatic in etiology, there have been suggestions that one can rationally extrapolate PTSD pharmacotherapy to DID.4 Such recommendations are made in spite of a conspicuous absence of controlled studies in the scientific literature. Inherent risks associated with the injudicious use of psychotropic agents include iatrogenic toxicity and substance abuse. A MEDLINE search (1980-1996) revealed a small number of case reports suggesting various agents to treat patients with switching behaviors (from I personality to another), as well as other symptoms of DID. Medications investigated as treatments include c1onazepam, c1onidine, carbamazepine, and lithium.4An examination of the literature indicates that at present, there have been no placebo-controlled or double-blind studies demonstrating either drug efficacy or clinical effectiveness in reducing dissociative symptoms. Until multimodality research exploring both psychotherapeutic and pharmacotherapeutic interventions provides more definitive answers, the decision to treat DID with medications is based largely on isolated case reports with nonexistent outcome data.