The case of a 42-year-old woman with delusional disorder, somatic type (DDST), with infestation delusion and delusions of body odor and halitosis accompanied by severe secondary depression is presented. These somatic delusions and depressive symptoms responded favorably to treatment with paroxetine 10 to 30 mg/d. Hypoperfusion in the left temporal and parietal lobes observed when she had marked clinical symptoms was improved at near recovery. The present report suggests that paroxetine is effective and a reasonable drug for DDST with secondary depression. It also supports previous observations that DDST is associated with hypoperfusion in the temporal and parietal lobes.