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Citalopram for treatment-resistant obsessive-compulsive disorder

Published online by Cambridge University Press:  16 April 2020

S. Pallanti ,
L. Quercioli ,
R.S. Paiva  and
L.M. Koran
S. Pallanti
Affiliation:
Istituto di Neuroscienze and University of Florence Medical SchoolFlorence, Italy
L. Quercioli
Affiliation:
Istituto di Neuroscienze FlorenceFlorence, Italy
R.S. Paiva
Affiliation:
Istituto di Neuroscienze FlorenceFlorence, Italy
L.M. Koran
Affiliation:
Department of Psychiatry and Behavioral Sciences, Stanford Medical Center Stanford CA, USA
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Summary

We investigated the comparative efficacy of citalopram vs. citalopram administered with clomipramine, in treatment-resistant obsessive-compulsive disorder (OCD).

Sixteen adult outpatients participated in a 90-day, randomized, open-label trial. Eligible patients were aged 18 to 45 years, had moderate to severe DSM-III-R OCD of ≥ one year's duration, a baseline Yale-Brown scale (Y-BOCS) score of ≥ 25 and no other active axis I diagnosis, and had failed adequate clomipramine and fluoxetine trials.

The citalopram-plus-clomipramine group (n = 9) experienced a significantly larger percent decrease in mean Y-BOCS score by day 90 than the citalopram alone group (n = 7). Only one citalopram patient decreased her score by ≥ 35%, and two by ≥ 25%. All nine citalopram-plus-clomipramine patients experienced decreases of 35%. Side effects were mild to moderate in both groups. We also treated with citalopram six OCD patients who had not tolerated fluoxetine alone and clomipramine alone; three achieved Y-BOCS score decreases of ≥ 35% at 90 days.

Since citalopram does not significantly affect clomipramine metabolism, the improvement in the combined drug group is unlikely to have resulted from increased plasma clomipramine levels. Double-blind controlled trials are needed of citalopram in OCD, and of combining citalopram with clomipramine in treatment-resistant OCD.

Keywords

citalopramcombined treatmentobsessive-compulsive disordertreatment-resistant
Type
Original articles
Information
European Psychiatry , Volume 14 , Issue 2 , April 1999 , pp. 101 - 106
Copyright
Copyright © Elsevier, Paris 1999

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