Page 35 - JCBP-3-2

Journal of Clinical and
Basic Psychosomatics Morgellons: Delusion or disease

In another retrospective analysis of 35 patients symptoms without requiring antipsychotics. In one of the
with Morgellons, 29 were administered phototherapy, first studies evaluating various treatments in patients with
supplementary oral antibiotics, an antipsychotic or both conditions, all individuals with depression exhibited
antidepressant, and an antiseptic wash. Of 26 individuals improvement with antidepressant therapy, with 75% and
prescribed with antipsychotics, 14 exhibited improved 25% of them achieving remission and demonstrating a
mental and physical health and 12 demonstrated significant response. 22
stabilized symptoms with sporadic episodes of fiber If an infectious etiology is suspected, particularly the
eruption. The study also determined that combining low- presence of Borrelia species, antibiotic therapy can be
dose antipsychotics, narrow-band phototherapy, and a considered. For instance, in a middle-aged Caucasian
topical antiseptic was the most effective treatment. The woman who developed the symptoms of Morgellons
most commonly used antipsychotics were quetiapine, shortly after a tick bite in the woodlands, treatment with
risperidone, olanzapine, aripiprazole, and amisulpride. 2
a 14-day course of oral doxycycline (100 mg twice daily)
Antipsychotics such as risperidone, pimozide, and led to remarkable clinical improvement. At the 2-week
58
olanzapine, in addition to hypnotherapy, have exhibited follow-up, her existing lesions were completely healed,
promise in reducing anxiety and pruritus symptoms. 37,58-60 with no new ulcerations observed.
These antipsychotics also improve skin healing once
secondary picking and excoriating behavior have stopped. For individuals who cannot or will not take
Similar to the antidepressant doxepin (either oral or antipsychotics, palliative therapies such as topical steroids,
topical), antipsychotics are utilized in certain situations emollients, and sedating or non-sedating antihistamines
can be an alternative for itching or sleep issues. Although
to improve the patients’ itch or ease their illness-related these treatments may lessen the symptoms, they do not
anxiety. Antihistamines, such as cyproheptadine, can slow the progression of the condition. Furthermore,
59
reduce pruritis and itch. However, there is a lack of studies medications, such as steroids are associated with some
supporting their use in Morgellons. 61
side effects. Antimicrobials, including oral doxycycline
58
Antipsychotics have demonstrated improved symptoms and topical clindamycin, have been used in patients with
after 2 weeks of use, with maximum effectiveness being Morgellons in whom the etiology or trigger was suspected
observed after 6 – 10 weeks. Once the delusion resolves, to be infectious in origin. 32
maintenance therapy with an effective dose is required for
3 months before progressively reducing it every 2 weeks 8.2. Non-pharmacological interventions
for approximately 6 months. Approximately 60 – 100% of For Morgellons, several non-pharmacological treatment
patients administered with any antipsychotic treatment options are available. Cognitive behavioral therapy,
undergo remission. However, relapse is seen in approximately particularly after administering antipsychotics, can enhance
25% of those who undergo the treatment again. 58 patient acceptance and the effectiveness of medication in
Although antipsychotics are undeniably crucial in the patients with Morgellons. It helps patients cope with the
psychopharmacotherapy of DI, viewing them as the only uncertainty of their condition, improves social functioning,
treatment option or assuming that their importance is promotes constructive symptom management strategies,
consistent in every case would be an oversimplification. and strengthens the patient–doctor relationship. 12,58,62
Antipsychotics are primarily indicated when there Morgellons disease, characterized by compulsive skin
are recurrent or chronic psychotic symptoms such as manipulation and sensations of itching or discomfort,
overvalued beliefs, delusions, or hallucinations. However, may also benefit from non-pharmacological interventions
they are not necessary for simple formication. In patients such as habit reversal training (HRT). HRT, a structured
with depression and concurrent symptoms of DI, component of cognitive behavioral therapy, has been
combining a simple antidepressant with electroconvulsive effective in treating body-focused repetitive behaviors
therapy or imipramine can effectively resolve the condition such as skin-picking and hair-pulling by helping patients
without using an antipsychotic. 58,60,62 recognize and control their triggers. In five key steps, HRT
Antipsychotic medications are the primary guides patients to increase awareness of their behaviors,
pharmacologic treatment for Morgellons. However, other establish healthy alternative actions, build motivation,
psychotropic drugs, including antidepressants, may be use relaxation techniques to manage stress, and practice
beneficial as complementary therapies. For patients these skills until they become habitual. Given its success
experiencing Morgellons symptoms and major depressive with other similar behaviors include depression, smoking,
disorder, antidepressants alone, such as amitriptyline, gambling problems, anxiety, procrastination, OCD, and
doxepin, and maprotiline, may effectively alleviate other behavioral problems, HRT is a promising therapeutic

Volume 3 Issue 2 (2025) 29 doi: 10.36922/jcbp.4735