Hostname: page-component-745bb68f8f-lrblm Total loading time: 0 Render date: 2025-01-26T11:33:39.472Z Has data issue: false hasContentIssue false
  • English
  • Français

Effectiveness of Long-Term Augmentation with Citalopram to Clomipramine in Treatment-Resistant OCD Patients

Published online by Cambridge University Press:  07 November 2014

Donatella Marazziti ,
Francesco Golia ,
Giorgio Consoli ,
Silvio Presta ,
Chiara Pfanner ,
Marina Carlini ,
Francesco Mungai  and
Mario Catena Dell'Osso
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction: The high percentage (between 40% and 60%) of resistance to first-line drugs, such as clomipramine or selective serotonin reuptake inhibitors, is a major problem in the pharmacologic management of obsessive-compulsive disorder (OCD). In these cases, different strategies have been employed with controversial outcomes. The meager information available on the association of two serotonergic drugs prompted us to explore the possible effectiveness and tolerability of citalopram+clomipramine in resistant OCD patients.

Methods: Twenty outpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD, who had failed to respond to at least two trials with a selective serotonin reuptake inhibitor and were currently taking clomipramine at different doses, were administered citalopram at a maximum dose of 60 mg/day. The clinical assessment was carried out at baseline (t0) and at the 4th (t1), 12th (t2), 24th (t3), 36th (t4), and 48th (t5) week by means of the Yale-Brown Obsessive Compulsive Scale, Hamilton Rating Scale for Depression, Clinical Global Impression scale, and the Dosage Record and Treatment Emergent Symptom Scale. The response was defined as a 35% decrease of the Yale-Brown Obsessive Compulsive Scale total score.

Results: The results showed that ∼50% of the patients improved significantly after 1 month of this regimen and after 1 year of treatment.

Conclusion: This study, although carried out in a small sample and in an open fashion, represents one of the few experiences with the association of two serotonergic compounds in resistant OCD and confirms its potential usefulness and good tolerability profile. Controlled research on this association in OCD is recommended.

Type
Original Research
Information
CNS Spectrums , Volume 13 , Issue 11 , November 2008 , pp. 971 - 976
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Saxena, S, Wang, D, Bystritsky, A, Baxter, LR Jr.Risperidone augmentation of SRI treatment for refractory obsessive-compulsive disorder. J Clin Psychiatry. 1996;57:303–306.Google Scholar
2.McDougle, CJ, Goodman, WK, Leckman, JF, Price, LH. The psychopharmacology of obsessive-compulsive disorder: implications for treatment and pathogenesis. Psychiatr Clin North Am. 1993;16:749–766.CrossRefGoogle ScholarPubMed
3.Byerly, MJ, Goodman, WK, Christensen, R. High doses of sertraline for treatment-resistant obsessive compulsive disorder. Am J Psychiatry. 1996;153:1232–1233.Google Scholar
4.Bejerot, S, Bodlund, O. Response to high doses of citalopram in treatment-resistant obsessive-compulsive disorder. Acta Psychiatr Scand. 1998;98:423–424.Google Scholar
5.Marazziti, D, Dell'Osso, L, Gemignani, A, et al.Citalopram in refractory obsessive-compulsive disorder: an open study. Int Clin Psychopharmacol. 2001;16:215–219.Google Scholar
6.Marazziti, D. Venlafaxine treatment of obsessive-compulsive disorder: case reports. CNS Spectr. 2003;8:421–422.CrossRefGoogle Scholar
7.Blier, P, Bergeron, R. Sequential administration of augmentation strategies in treatment-resistant obsessive-compulsive disorder: preliminary findings. Int Clin Psychopharmacol. 1996;11:37–44.Google Scholar
8.Pigott, TA, L'Heureux, F, Hill, JL, Bihari, K, Bernstein, SE, Murphy, DL. A double-blind study of adjuvant buspirone hydrochloride in clomipramine-treated patients with obsessive-compulsive disorder. J Clin Psychopharmacol. 1992;12:11–18.Google Scholar
9.Marazziti, D, Gemignani, A, Dell'Osso, L. Trazodone augmentation in OCD: a case-series report. CNS Spectr. 1999;4:48–49.CrossRefGoogle ScholarPubMed
10.Hermesh, H, Aizenberg, D, Numitz, H. Trazodone treatment in clomipramine-resistant obsessive-compulsive disorder. Clin Neumpharmacol. 1990;13:322–328.Google Scholar
11.Danon, PN, Sassoon, Y, Hirschmann, S, Yancu, I, Grunhaus, LJ, Zohar, J. Pindolol augmentation in treatment-resistant obsessive-compulsive disorder: a double-blind- placebo controlled trial. Eur Neuropsychopharmachol. 2000;10:165–169.Google Scholar
12.Maina, G, Albert, U, Ziero, S, Bogetto, F. Antipsychotic augmentation for treatment resistant obsessive-compulsive disorder: what if antipsychotic is discontinued? Int Clin Psychopharmacol. 2003;18:23–28.Google ScholarPubMed
13.Hollander, E, Baldini Rossi, N, Sood, E, Pallanti, S. Risperidone augmentation in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study. Int J Neuropsychopharmacol. 2003;6:397–401.Google Scholar
14.Shapira, NA, Ward, HE, Mandoki, M, et al.A double-blind, placebo controlled trial of olanzapine addition in fluoxetine-refractory obsessive-compulsive disorder. Biol Psychiatry. 2004;55:553–555.Google Scholar
15.McDougle, CJ. Update on pharmacologic management of OCD: agents and augmentation. J Clin Psychiatry. 1997;58:12:11–17.Google Scholar
16.Marazziti, D, Mungai, F, Vivarelli, L, Dell'Osso, B. Critical issues in the pharmacological treatment of obsessive-compulsive disorder. Clin Neuropsychiatry. 2004;1:59–64.Google Scholar
17.Bloch, MH, Landeros-Weisenberger, A, Kelmendi, B, Coric, V, Bracken, MB, Leckman, JF. A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry. 2006;11:622–632.Google Scholar
18.Fineberg, NA, Sivakumaran, T, Roberts, A, Gale, T. Adding quetiapine to SRI in treatment-resistant obsessive-compulsive disorder: a randomized controlled treatment study. Int Clin Psychopharmacol. 2005;20:223–226.Google Scholar
19.Koran, LM, Saxena, S. Issues and strategies in treating refractory obsessive-compulsive disorder. CNS Spectr. 2002;5:24–31.Google Scholar
20.Simeon, JC, Thatte, S, Wiggins, D. Treatment of adolescent obsessive-compulsive disorder with a clomipramine-fluoxetine combination. Psychopharmacol Bull. 1990;26:285–290.Google Scholar
21.Browne, M, Horn, E, Jones, TT. The benefits of Clomipramine-fluoxetine combination in obsessive-compulsive disorder. Can J Psychiatry. 1993;38:242–243.CrossRefGoogle ScholarPubMed
22.Figueroa, Y, Rosenberg, DR, Birmaher, B, Keshavan, MS. Combination treatment with clomipramine and selective serotonin reuptake inhibitors for obsessive-compulsive disorder in children and adolescents. J Child Adolesc Psychopharmacol. 1998;8:61–67.CrossRefGoogle ScholarPubMed
23.McDougle, CJ, Goodman, WK. Combination pharmacological treatment strategies. In: Hollander, E, Stein, D, eds. OCD: Diagnosis, Etiology and Treatments. New York, NY: Marcel Dekker; 1999:203–223.Google Scholar
24.Ravizza, L, Barzega, G, Bellino, S, Bogetto, F, Maina, G. Drug treatment of obsessive compulsive disorder (OCD): long-term trial with clomipramine and selective serotonin reuptake inhibitors (SSRIs). Psychopharmacol Bull. 1996;32:167–173.Google Scholar
25.Pallanti, S, Quercioli, L, Paiva, RS, Koran, LM. Citalopram for treatment-resistant obsessive-compulsive disorder. Eur Psychiatry. 1999;14:101–106.Google Scholar
26.First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-1 P, Version 2.0, 4 97 revision). New York, NY: Biometrics Research, New York State Psychiatric Institute; 1997.Google Scholar
27.Lensi, P, Cassano, GB, Correddu, G, Ravagli, S, Kunovac, JL, Akiskal, HS. Obsessive-compulsive disorder. Familial-developmental history, symptomatology, comorbidity and course with special reference to gender-related differences. Br J Psychiatry. 1996;169:101–107.Google Scholar
28.Goodman, WK, Price, LH, Rasmussen, SA, et al.The Yale-Brown Obsessive Compulsive Scale. II. Validity. Arch Gen Psychiatry. 1989;46:1012–1016.Google Scholar
29.Hamilton, M. A rating scale for depression. J Neurol Neurosurg Psychiatry. 1960;23:56–62.Google Scholar
30.Guy, W. ECDEU Assessment Manual for Psychopharmacology. Clinical Global Impressions (028-CGI). Rockville, Md: United States Department of Health Education and Welfare; 1976:217–222.Google Scholar
31.Guy, W. ECDEU Assessment Manual for Psychopharmacology. Rockville, Md: US Department of Health, Education and Welfare (ADM) Government Printing Office; 1976:223–224.Google Scholar
32.Pallanti, S, Hollander, E, Bienstock, C, et al.International Treatment Refractory OCD Consortium. Treatment non-response in OCD: methological issues and operational definitions. Int J Neuropsychopharmacol. 2002;5:181–191.CrossRefGoogle Scholar
33.Pallanti, S, Quercioli, L. Treatment-refractory obsessive-compulsive disorder: methodological issues, operational definitions and therapeutic lines. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30:400–412.Google Scholar
34.Tolin, DF, Abramowitz, JS, Diefenbach, GJ. Defining response in clinical trials for obsessive-compulsive disorder: a signal detection of the Yale-Brown obsessive-compulsive scale. J Clin Psychiatry. 2005;66:1549–1557.Google Scholar
35.Simpson, HB, Huppert, JD, Petkova, E, Foa, EB, Liebowitz, MR. Response versus treatment in obsessive-compulsive disorder. J Clin Psychiatry. 2006;67:269–276.CrossRefGoogle ScholarPubMed
36.Montgomery, SA, Kasper, S, Stein, D, et al.Citalopram 20mg, 40mg and 60mg are all effective and well tolerated compared with placebo in obsessive-compulsive disorder. Int Clin Psychopharmacol. 2001;16:75–86.Google Scholar
37.Ananth, J, Pecknold, JC, van den Steen, N, Engelsmann, F. Double-blind comparative study of clomipramine and amitriptyline in obsessive neurosis. Prog Neuropsychopharmacol. 1981;5:257–262.Google Scholar
38.Ananth, J. Clomipramine: an antiobsessive drug. Can J Psychiatry. 1986;31:253–258.Google Scholar
39.Zohar, J, Insel, TR. Drug treatment of obsessive-compulsive disorder. J Affect Disord. 1987;13:193–202.Google Scholar
40.De-Veaugh-Geiss, J, Landau, P, Katz, R. Treatment of obsessive-compulsive disorder with clomipramine. Psychiatr Ann. 1989;19:97–101.CrossRefGoogle Scholar
41.Thomsen, PH, Ebbesen, C, Persson, C. Long-term experience with citalopram in the treatment of adolescent OCD. J Am Acad Child Adolesc Psychiatry. 2001;40:895–902.Google Scholar