Effect of milnacipran on insight and stress coping strategy in patients with Taijin Kyofusho

Objective Taijin-Kyofusho (TKS) is a Japanese culture-bound syndrome similar to social anxiety disorder. Recent studies have shown antidepressants to be effective in treating TKS. The effects on insight or coping strategies have not, however, been studied. The present study investigated changes in insight and stress coping strategies during treatment with milnacipran. Method The study was a 12-week open trial in 16 patients with offensive type TKS. Offensive anxiety was assessed by an original TKS scale. Insight regarding TKS symptoms was assessed by the "Insight into obsessions and compulsions" subscale of the Yale-Brown Obsessive Compulsive Scale. Coping strategies were assessed by the Coping Inventory for Stressful Situations. The primary efficacy variable was global improvement on the Clinical Global Impression scale (CGI). Results Of the sixteen patients, only 10 completed the study and seven patients responded to the drug (a score of 2 or less on CGI at endpoint). Six patients dropped out in the first few days because of nausea. Last observation carried forward analysis (N=16) showed a significant reduction of offensive anxiety of TKS. Insight and emotional coping strategies were also significantly improved. Conclusion The results suggested that not only TKS symptoms, but also insight and stress coping, may be improved by treatment with milnacipran.