Treating Misophonia

[SpongeBob DoctorPants]

I can't say I ever had this come up in my residency or fellowship training, but since being in practice for the past six months I have had three patients with symptoms characteristic of misophonia. I'm wondering if anyone here has had success in treating this condition, and if so, what was done?

One of my patients is a young girl whose mother started her on an over-the-counter magnesium supplement, and apparently she has responded very well. I was intrigued and found online that magnesium has worked for many people, but not everyone. Just wondering what else has been tried out there and what has worked.

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[WisNeuro]

First, make sure it's not a somaticization, as this happens a lot. Additionally, it sometimes masks more general increased irritability that arises from a variety of things. After that I know some people who have had some success with an exposure based type of treatment that utilizes some CBT for emotional and/or irrational appraisals if they exist.

 

[tr]

I'd like to hear more. I haven't had any success getting people with misophonia to do exposure therapy. It seems like there is no way to get a graded scale: either the stimulus is subthreshold and it doesn't bother them (like watching videos of people chewing with the sound off), or it's so bothersome they won't do the exposure (like as soon as you turn on the sound they will refuse to participate).
Sometimes people with baseline irritability seem to get a little relief from the degree of irritation once their SSRI helps with the irritability, but it doesn't make the misophonia go away, just dampens the response a little bit.

The magnesium thing is interesting, I will try that next time. It seems pretty benign and I sure haven't found anything else that's worked. Is there any speculation about the mechanism of action at all?

 

[thoffen]

I have no experience or training about this illness (complaint?), but it makes me think of sensory integration difficulties. I wonder if OT evaluation would be of any value.

 

[WisNeuro]

I'd like to hear more. I haven't had any success getting people with misophonia to do exposure therapy. It seems like there is no way to get a graded scale: either the stimulus is subthreshold and it doesn't bother them (like watching videos of people chewing with the sound off), or it's so bothersome they won't do the exposure (like as soon as you turn on the sound they will refuse to participate).
Sometimes people with baseline irritability seem to get a little relief from the degree of irritation once their SSRI helps with the irritability, but it doesn't make the misophonia go away, just dampens the response a little bit.

The magnesium thing is interesting, I will try that next time. It seems pretty benign and I sure haven't found anything else that's worked. Is there any speculation about the mechanism of action at all?

You won't find all that much in the literature. It's still a somewhat "controversial" thing, with some people thinking it's pretty much a somaticization issue. That being said, as far as treatment, it's mostly small case studies, and generally CBT in nature.

 

[SpongeBob DoctorPants]

I agree that it is difficult to find much in the literature. From what I have read, a high level of glutamate is associated with sound sensitivity, and magnesium helps to dampen the effects of glutamate. I have also read that some forms of therapy may be helpful, such as CBT or OT. In the case of my patient who is a young girl with autism, I don't think she would do very well with therapy, but her mother swears by the magnesium gluconate and magnesium citrate that she has been taking. I have read that chelated magnesium may also work well for this problem. I don't know if it matters much which form of magnesium is taken, but there is a variety of supplements out there.

 

[birchswing]

I agree that it is difficult to find much in the literature. From what I have read, a high level of glutamate is associated with sound sensitivity, and magnesium helps to dampen the effects of glutamate. I have also read that some forms of therapy may be helpful, such as CBT or OT. In the case of my patient who is a young girl with autism, I don't think she would do very well with therapy, but her mother swears by the magnesium gluconate and magnesium citrate that she has been taking. I have read that chelated magnesium may also work well for this problem. I don't know if it matters much which form of magnesium is taken, but there is a variety of supplements out there.

Yeah, there are some differences. Some forms can apparently cross the brain blood barrier better than others. I've seen magnesium threonate promoted for that. Magnesium glycinate contains glycine, which is used by itself for schizophrenia and acutely in stroke victims. I've experimented with different ones and found different effects.

Also, what about earplugs? I am very sensitive to sound and light and wear a type of earplug that lets in enough sound for me to hear but attenuates the volume.

 

[Zenman1]

I've seen it mostly in patients with ADHD, and treatment for that seemed to help. Some of my patients with PTSD are sensitive to noise but I think that's another matter.

 

[3lefts]

I spent some time in a dysautonomia clinic where many of the patients had centrally-mediated issues with chronic pain and/or chronic nausea. A lot of them were also pretty reactive to light, sounds and smells. A couple months doing 40 minutes of cardio 4x/wk really seems to tone down sensory stimulation.