Posted by SLS on November 22, 2009, at 7:13:42
In reply to Re: Treatment resistant OCD, posted by hopefullynow on November 22, 2009, at 0:04:56
Here is the protocol used for a recently completed study of OCD.
http://clinicaltrials.gov/ct2/show/NCT00564564
The results are here:
http://jop.sagepub.com/cgi/content/abstract/0269881108099423v1
Personally, I think the 75mg dosage of Anafranil (clomipramine) used in this study was too low.
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"Initial Treatment/Dose Adjustment (Adults)
Treatment with Anafranil should be initiated at a dosage of 25 mg daily and gradually increased, as tolerated, to approximately 100 mg during the first 2 weeks. During initial titration, Anafranil should be given in divided doses with meals to reduce gastrointestinal side effects. Thereafter, the dosage may be increased gradually over the next several weeks, up to a maximum of 250 mg daily. After titration, the total daily dose may be given once daily at bedtime to minimize daytime sedation."
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Here is a study that demonstrated a greater improvement in OCD using the combination of citalopram and clomipramine. Unfortunately, dosages are not detailed in the abstract.
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Citalopram for treatment-resistant obsessive-compulsive disorderS. Pallanti1, L. Quercioli2, R. S. Paiva2 and L. M. Koran3
1 Istituto di Neuroscienze and University of Florence Medical School, Florence, Italy
2 Istituto di Neuroscienze Florence, Florence, Italy
3 Department of Psychiatry and Behavioral Sciences, Stanford Medical Center, Stanford, CA, USA
AbstractWe 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.
----------------------------------------------------- Scott
poster:SLS
thread:926438
URL: http://www.dr-bob.org/babble/20091117/msgs/926517.html