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Uso de citalopram para trastorno obsesivo-compulsivo resistente al tratamiento

Published online by Cambridge University Press:  12 May 2020

S. Pallanti ,
L. Quercioli ,
R.S. Paiva  and
L.M. Koran
S. Pallanti
Affiliation:
Instituto de Neurociencia y Escuela Médica Universitaria de Florencia, Florencia
L. Quercioli
Affiliation:
Instituto de Neurociencia de Florencia, Florencia, Italia
R.S. Paiva
Affiliation:
Instituto de Neurociencia de Florencia, Florencia, Italia
L.M. Koran
Affiliation:
Departamento de Psiquiatría, Centro Médico Stanford, Stanford, CA, EE.UU
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Resumen

Hemos investigado la eficacia comparativa del citalopram frente a citalopram administrado con clomipramina en trastorno obsesivo-compulsivo (OCD) resistente al tratamiento. Dieciséis pacientes ambulatorios adultos participaron en un ensayo abierto distribuido al azar de 90 días. Los pacientes elegibles tenían de 18 a 45 años, OCD del DSM-III-R de moderado a grave de un año o más de duración, una puntuación de línea de base en la escala de Yale-Brown (Y-BOCS) de 25 o más y ningún otro diagnóstico activo del eje I, y habían tenido fracasos en ensayos adecuados de clomipramina y fluoxetina. El grupo de citalopram más clomipramina (n = 9) experimentó una disminución de porcentaje significativamente mayor en la puntuación media de la Y-BOCS para el día 90 que el grupo de citalopram solo (n = 7). Unicamente una paciente de citalopram disminuyó su puntuación en 35% o más, y dos en 25% o más. Los nueve pacientes de citalopram más clomipramina experimentaron disminuciones de 35% o más. Los efectos secundarios fueron de leves a moderados en ambos grupos. También tratamos con citalopram a seis pacientes de OCD que no habían tolerado la fluoxetina y la clomipramina solas; tres lograron disminuciones de la puntuación de la Y-BOCS de 35% o más a los 90 días. Puesto que el citalopram no afecta significativamente al metabolismo de la clomipramina, es poco probable que la mejoría en el grupo de combinación de medicamentos se haya derivado de mayores niveles de clomipramina en plasma. Se precisan ensayos controlados doble ciego de citalopram en OCD y de combinación de citalopram con clomipramina en OCD resistente al tratamiento.

Keywords

citalopramtratamiento combinadotrastorno obsesivo-compulsivoresistente al tratamiento
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 6 , Issue 7 , October 1999 , pp. 441 - 447
Copyright
Copyright © European Psychiatric Association 1999

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