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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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References

Baettig, DBondolfi, GMontaldi, SAmey, MBaumann, P. Tricyclic antidepressant plasma levels after augmentation with citalopram: a case study. Eur J Clin Pharmacol 1993 ; 44 : 403–405.CrossRefGoogle ScholarPubMed
Bejerot, SHumble, M. Citalopram treatment of OCD: a pilot study of anti-obsessive efficacy. Biol Psychiatry 1991 ; 29 : 443–447.Google Scholar
Brøsen, K. The pharmacogenetics of the selective serotonin re-uptake inhibitors. Clin Invest 1993 ; 71 : 1002–1009.10.1007/BF00180032CrossRefGoogle Scholar
Brøsen, KSkjelbo, ERasmussen, BBPoulsen, HELoft, S. Fluvoxamine is a potent inhibitor of cytochrome P4501A2. Biochem Pharmacol 1993 ; 45 : 1211–1214.CrossRefGoogle ScholarPubMed
Browne, MHornm, EJones, TT. The benefits of clomipramine-fluoxetine combination in obsessive compulsive disorder. Can J Psychiatry 1993 ; 38 : 242–243.CrossRefGoogle ScholarPubMed
Figueroa, YRosenberg, DRBirmaher, BKeshavan, MS. Combination treatment with clomipramine and selective serotonin reuptake inhibitors for obsessive-compulsive disorder in children and adolescents. J Child Adolescent Psychopharmacol 1998 ; 8 : 61–67.10.1089/cap.1998.8.61CrossRefGoogle ScholarPubMed
Goodman, WKMcDougle, CJPrice, LH. Pharmacotherapy of obsessive compulsive disorder J Clin Psychiatry. 1992 ; 53 : Suppl 4 : 29–37.Google ScholarPubMed
Goodman, WKMcDougle, CJBarr, LCAronson, SCPrice, LH. Biological approaches to treatment-resistant obsessive compulsive disorder. J Clin Psychiatry 1993 ; 54 Suppl 6 : 16–26.Google ScholarPubMed
Goodman, WKPrice, LHRasmussen, SAMazure, CDelgado, PHeninger, GRet alThe Yale-Brown Obsessive Compulsive Scale I: development, use, and reliability. Arch Gen Psychiatry 1989 ; 46 : 1006–1111.CrossRefGoogle ScholarPubMed
Greist, JHJefferson, JWKobak, KAKatzelnick, DJSerlin, RC. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. Arch Gen Psychiatry 1995 ; 52 : 53–60.CrossRefGoogle ScholarPubMed
Greist, JHJefferson, JWKobak, KAChouinard, GDuboff, EHalaris, Aet alA 1 year double-blind placebo-controlled fixed dose study of sertraline in the treatment of obsessive-compulsive disorder. Int Clin Psychopharmacol 1995 ; 10 : 57–65.CrossRefGoogle ScholarPubMed
Guy, W. ECDEU Assessment Manual for Psychopharmacology Washington DC: US Dept of Health, Education, and Welfare 1976; Publication No. 76-338Google Scholar
Hamilton, M. A rating scale for depression J Neurol Neurosurg Psychiatry 1960 ; 23 : 56–66.CrossRefGoogle ScholarPubMed
Härtter, SArand, MOesch, FHiemke, K. Non-competitive inhibition of clomipramine N–demethylation by fluvoxamine. Psychopharmacology 1995 ; 117 : 149–153.CrossRefGoogle ScholarPubMed
Hyttel, J. Neurochemical characterization of a new potent and selective serotonin uptake inhibitor: Lu 10—171. Psychopharmacology 1977 ; 51 : 225–233.CrossRefGoogle ScholarPubMed
Hyttel, J. Comparative pharmacology of SSRIs Nord Psykiatr Tidsskr 1993 ; 47 Suppl 30 : 5–12.CrossRefGoogle Scholar
Hyttel, J. Pharmacological characterization of selective serotonin re-uptake inhibitors (SSRIs). Int Clin Psychopharmacol 1994 ; 9 Suppl 1 : 19–26.10.1097/00004850-199403001-00004CrossRefGoogle Scholar
Hytell, JBøgesø, KPPerregaard, JSanchez, C. The pharmacological effect of citalopram resides in the (S)-(+) enantiomer. J Neural Transm 1992 ; 88 : 157–160.CrossRefGoogle Scholar
Hyttel, JLarsen, JJ. Serotonin-selective antidepressants. Acta Pharmacol Toxicol 1985 ; 56 Suppl 1 : 146–153.CrossRefGoogle ScholarPubMed
Jenike, MARauch, SL. Managing the patient with treatment-resistant obsessive compulsive disorder: current strategies. J Clin Psychiatry 1994 ; 55 Suppl 3 : 11–17.Google ScholarPubMed
Jefferson, JWAltemus, MJenike, MAPigott, TAStein, DJ. Algorithm for the treatment of obsessive-compulsive disorder (OCD). Psychopharm Bull 1995 ; 31 : 487–490.Google ScholarPubMed
Koponen, HLepola, ULeinonen, EJakinen, RPenttinen, JTurtonen, J. Citalopram in the treatment of obsessive compulsive disorder: An open pilot study. Acta Psychiatr Scand 1997 ; 96 : 343–346.CrossRefGoogle Scholar
Koran, LMSallee, FRPallanti, S. Rapid benefit of intravenous pulse loading of clomipramine in obsessive-compulsive disorder. Am J Psychiatry 1997 ; 154 : 396–401.Google ScholarPubMed
Leckman, JFRiddle, MAHardin, MTOrt, SISwartz, KLStevenson, Jet alThe Yale global Tic severity scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 1989 ; 28 : 566–573.CrossRefGoogle ScholarPubMed
Lesch, KPHoh, ADisselkamp-Tietze, JWiesmann, MOsterheider, MSchulte, HM. 5—Hydroxytryptamine 1α receptor responsivity in obsessive-compulsive disorder. Arch Gen Psychiatry 1991 ; 48 : 540–547.CrossRefGoogle Scholar
Madsen, HNielsen, KKBrøsen, K. Imipramine metabolism in relation to the sparteine and mephenytoin oxidation polymorphisms — a population study. Br J Clin Pharmacol 1995 ; 39 : 433–439.CrossRefGoogle ScholarPubMed
March, JSFrances, ACarpenter, DKahn, DA. The expert consensus guideline series: treatment of obsessive-compulsive disorder. J Clin Psychiatry 1997 ; Suppl 4 : 1–72.Google Scholar
McDougle, CJGoodman, WKLeckman, JFLee, NCHeninger, GRPrice, LH. Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder. Arch Gen Psychiatry 1994 ; 51 : 302–308.CrossRefGoogle ScholarPubMed
Mundo, EBianchi, LBellodi, L. Efficacy of fluvoxamine, paroxetine, and citalopram in the treatment of obsessive-compulsive disorder: a single-blind study. J Clin Psychopharmacol 1997 ; 17 : 267–271.CrossRefGoogle ScholarPubMed
Overø, FK. Preliminary studies of the kinetics of citalopram in man. Eur J Clin Pharmacol 1978 ; 14 : 69–73.CrossRefGoogle ScholarPubMed
Overø, FKToft, BChristophersen, LGylding-Sabroe, JP. Kinetics of citalopram in elderly patients. Psychopharmacology 1985 ; 86 : 253–257.CrossRefGoogle Scholar
Pedersen, LOKragh-Sørensen, PBjerre, MOverø, FKGram, LF. Citalopram, a selective serotonin re-uptake inhibitor: clinical antidepressive and long-term effect — a phase II study. Psychopharmacology 1982 ; 77 : 199–204.CrossRefGoogle ScholarPubMed
Rasmussen, BBMäenpää, JPelkonen, OLoft, SPoulsen, HELykkesfeldt, Jet alSelective serotonin re-uptake inhibitors and theophylline metabolism in human liver microsomes: potent inhibition by fluvoxamine. Br J Clin Pharmacol 1995 ; 39 : 151–159.10.1111/j.1365-2125.1995.tb04422.xCrossRefGoogle Scholar
Rauch, SLO'Sullivan, RLJenike, M.A.. Open treatment of obsessive-compulsive disorder with venlafaxine: a series of ten cases J Clin Psychopharmacol 1996 ; 16 : 81–84.CrossRefGoogle ScholarPubMed
Ravizza, LBarzega, GBellino, SBogetto, FMaina, G. Therapeutic effect and safety of adjunctive risperidone in refractory obsessive-compulsive disorder (OCD). Psychopharmacol Bull 1996 ; 32 : 677–682.Google ScholarPubMed
Simeon, JGThatte, SWiggins, D. Treatment of adolescent obsessive-compulsive disorder with a clomipramine-fluoxetine combination Psychopharmacol Bull 1990 ; 26 : 285–290.Google ScholarPubMed
Sindrup, SHBrøsen, KHansen, MGJAaes-Jørgensen, TOverø, KFGram, LF. Pharmacokinetics of citalopram in relation to the sparteine and the mephenytoin oxidation polymorphisms. Ther Drug Monit 1993 ; 15 : 11–17.CrossRefGoogle ScholarPubMed
Spitzer, RLWilliams, JBLGibbon, MFirst, MB. Structured Clinical Interview for DSM-III-R-Personality Disorders (SCID-II, version 1.0). Washington, DC: American Psychiatric Press; 1990.Google Scholar
Spitzer, RLWilliams, JBLGibbon, MFirst, MB. The Structured Clinical Interview for DSM-III-R (SCID), I: history, rationale, and description Arch Gen Psychiatry 1992 ; 49 : 624–629.CrossRefGoogle ScholarPubMed
Symes, MH. Cardiovascular effects of clomipramine (Anafranil). J Int Med Res 1973 ; 1 : 460–463.10.1177/030006057300100538CrossRefGoogle Scholar
Szegedi, AWetzel, HLeal, MHärtter, SHiemke, C. Combination treatment with clomipramine and fluvoxamine: drug monitoring, safety, and tolerability data. J Clin Psychiatry 1996 ; 57 : 257–264.Google ScholarPubMed
Thomsen, PH. Child and adolescent obsessive-compulsive disorder treated with citalopram: Findings from an open trial of 23 cases. J Child Adolesc Psychopharmacol 1997 ; 7 : 157–166.CrossRefGoogle ScholarPubMed
Tollefson, GDBirkett, MKoran, LGenduso, L. Continuation treatment of OCD: double-blind and open-label experience with fluoxetine. J Clin Psychiatry 1994 ; 55 Suppl 10 : 69–76.Google ScholarPubMed
Wade, AGLepola, UKoponen, HJPedersen, VPedersen, T. The effect of citalopram in panic disorder. Br J Psychiatry 1997 ; 170 : 549–553.CrossRefGoogle ScholarPubMed
White, KKeck, PELipinski, J. Serotonin-uptake inhibitors in obsessive-compulsive disorder: a case report. Comp Psychiatry 1986 ; 27 : 211–214.CrossRefGoogle ScholarPubMed
Zohar, JJudge, Rthe OCD Paroxetine Study Investigators. Paroxetine vs. clomipramine in the treatment of obsessive-compulsive disorder. Br J Psychiatry 1996 ; 169 : 468–474.CrossRefGoogle Scholar
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