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To the Editor: Multiple chemical sensitivity syndrome is thought by some to be caused by extreme sensitivity to chemical "incitants" in concentrations that are ordinarily well tolerated (1). These patients typically report multiple somatic complaints and develop behavioral changes congruent with their beliefs about symptom causation. We report on a woman who was successfully treated for this condition with paroxetine.
Ms. A was a 44-year-old woman who had developed a fear of strong chemical odors 2 years earlier after exposure to natural gas at work over a 2-week period. She reported episodic lightheadedness, a tingling of her lips, and an unsteady gait. She was moved to another part of the work site, and her symptoms disappeared. Several weeks later, after returning to her usual workstation, she developed diffuse muscle weakness, headache, nausea, and cloudy vision. An emergency medical team arranged for her to be flown to a tertiary care medical center 80 miles away. Results of a medical evaluation were unremarkable, and she was discharged the next day.
Over the ensuing months, Ms. A developed "reactions" when exposed to strong odors, which led her to alter her behavior. She stopped working and avoided attending church and shopping. She was diagnosed with multiple chemical sensitivity syndrome and subsequently obtained workers’ compensation.
Ms. A was referred to the psychiatry department for evaluation. She had mild depression that did not fulfill criteria for major depressive disorder. She expressed a fear of chemical odors and described "reactions" that were identical to panic attacks. She was diagnosed with panic disorder with agoraphobia and was treated with paroxetine, 20 mg/day; her dose was gradually increased to 40 mg/day. Trazodone, 100 mg at bedtime, was prescribed.
Within 3 months, Ms. A was no longer depressed, and her "reactions" to chemical odors had stopped. She was able to shop unaccompanied and attend church. By her 5-month follow-up, Ms. A had returned to work and remained free of the "reactions." She has now been followed for nearly 4 years while receiving maintenance treatment with paroxetine, 40 mg/day, and trazodone, 100 mg at bedtime; she continues to be symptom free. She still believes that chemical odors induced her multiple chemical sensitivity syndrome.
The treatment of patients diagnosed with multiple chemical sensitivity syndrome has been troublesome and has generally been the province of nontraditional medical practitioners. This case joins two others (2, 3) in showing that some patients diagnosed with multiple chemical sensitivity syndrome have an underlying psychiatric disorder that, when identified, responds to medication therapy.
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