Open trial of milnacipran for Taijin-Kyofusho in Japanese patients with social anxiety disorder

Objective: Taijin-Kyofusho (TKS) is thought to be a distinct form of social anxiety disorder specific to Japanese culture in which the patient suffers from intense fear that his or her body or its functions are offensive to other people; although previously Japanese experts have insisted that the "offensive" type of TKS and the typical type (Which is similar to social anxiety disorder in Western countries) could not be considered separately. Selective serotonin reuptake inhibitors, and more recently serotonin and noradrenaline reuptake inhibitors (SNRI), have been shown to be effective in treating social anxiety disorders. However, the efficacy of SNRI has not yet been assessed in TKS. Methods: The present study was a 12-week open trial of the SNRI, milnacipran (Toledomin(R), Ixel(R)) in 12 patients with offensive type of TKS (also with social anxiety disorder, if DSM-IV diagnostic criteria were expanded). Diagnostic criteria of TKS and a TKS severity scale were developed from the symptomatology described in the Japanese literature. The primary criterion for response was improvement on the Clinical Global Impression (CGI). TKS offensive anxiety scale (0-3), the Liebowitz Social Anxiety Scale (LSAS), the Sheehan Disability Scale, and several self-reporting questionnaires were also used. Results: Six of the 11 patients completing therapy responded ("much improved" or "very much improved" on CGI). The mean LSAS score and TKS offensive anxiety showed statistically significant reductions. Conclusion: The results suggest that the SNRI, milnacipran, may be helpful in the treatment of TKS. Further studies with milnacipran in TKS appear warranted.