Stopping uncontrolled shopping
Compulsive shopping has no standard treatment, but evidence shows benefit from some SSRIs and psychotherapies.
Fluvoxamine. An early case series suggested antidepressants could curb compulsive buying,5 but later research has yielded mixed results.
Ms. A entered an experimental drug trial. She was randomly assigned to receive fluvoxamine and—despite difficulties with oversedation—tolerated a sustained dosage of 100 mg/d. After the 9-week trial, Ms. A said she thought less frequently about shopping, felt less compulsion to shop, and was spending less money and time shopping.
This open-label trial we conducted indicated that fluvoxamine, up to 300 mg/d, could be an effective treatment for compulsive buying.11 Two subsequent randomized controlled trials, however, found fluvoxamine did no better than placebo when treating compulsive shoppers.12,13
Citalopram. In an open-label trial,14 23 women and 1 man who met diagnostic criteria for compulsive shopping disorder (YBOCS-SV scores ≥17) received citalopram for 7 weeks. Dosages started at 20 mg/d and were increased as tolerated to 60 mg/d. Fifteen patients (63%) met response criteria—“much improved” or “very much improved” as measured by the Clinical Global Impressions-Improvement scale and a ≥50% decrease in YBOCS-SV score. Three patients (13%) discontinued treatment because of adverse effects (headache, rash, insomnia).
The 15 responders were then enrolled in a 9-week double-blind, placebo-controlled trial. Compulsive shopping symptoms recurred in 5 of 8 patients (63%) assigned to placebo, compared with none of the 7 who continued taking citalopram.
By comparison, escitalopram, 10 to 20 mg/d, showed little effect for compulsive shopping symptoms in an identically designed discontinuation trial by the same investigators. During the 7-week, open-label trial, 19 of 26 patients met response criteria. In the 9-week double-blind, controlled phase, however, 63% of initial responders relapsed while taking escitalopram, compared with 67% of those randomized to placebo.15
A naturalistic follow-up study of 24 patients treated with citalopram, 20 to 60 mg/d, noted that patients who responded at 3 months were more likely to be symptom-free after 1 year than those who did not respond to acute treatment.16 Responders’ mean 2-week compulsive spending declined from $773 before treatment to $351 at 12 months, and their mean total debt declined from $17,833 to $16,752.
Because remission was not significantly associated with taking citalopram, however, the authors concluded that the mechanisms responsible for maintaining remission were unclear.
Psychotherapy. Cognitive-behavioral therapy (CBT) may help, but few therapists are familiar with this disorder. CBT challenges the patient’s cognitive distortions and faulty schemas about shopping, such as:
- “Having the latest fashions will make me more popular.”
- “Having 5 pair of new shoes will make me a happier and better person.”
Our recommendations. Medication—such as an antidepressant for major depression or a mood stabilizer for bipolar disorder—may improve compulsive shopping in patients with a comorbid psychiatric disorder. For other compulsive shoppers, however, medication trials provide little guidance for treatment.
We inform patients such as Ms. A that they cannot rely on medication to control their behavior. Instead, we recommend a four-step approach to break the compulsive shopping habit (Table 3).
Financial counseling, provided free of charge by many banks, benefits some patients. Self-help books describe strategies to overcome compulsive spending (Related resources). Debtors Anonymous, a 12-step program patterned after Alcoholics Anonymous, also can help by offering acceptance, belonging, forgiveness, and understanding.
In the most severe cases we recommend appointing a financial conservator to control the patient’s finances. We rarely advise this strategy but have encountered cases in which there seemed to be no other option. Having a conservator controls the patient’s spending but does not reverse the preoccupation with shopping.
Table 3
Patient education: 4 steps to control compulsive spending
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For clinicians
- Black DW. Assessment of compulsive buying. In: Benson AL (ed). I shop, therefore I am: Compulsive buying and the search for self. Northvale, NJ: Jason Aronson; 2000:191-216.
- Arenson G. Born to spend: how to overcome compulsive spending. Blue Ridge Summit, PA: Tab Books, 1991.
- Benson AL. Stopping Overshopping. A site for shopaholics and the people who love them. www.stoppingovershopping.com.
- Mellan O. Money harmony: resolving money conflicts in your life and relationships. New York: Walker, 2005.