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Intravenous Clomipramine for Obsessive-Compulsive Disorder Refractory to Oral Clomipramine
A Placebo-Controlled Study
Brian A. Fallon, MD;
Michael R. Liebowitz, MD;
Raphael Campeas, MD;
Franklin R. Schneier, MD;
Randall Marshall, MD;
Sharon Davies, RN;
Debbie Goetz, MS;
Donald F. Klein, MD
Arch Gen Psychiatry. 1998;55:918-924.
Background Uncontrolled reports suggest that intravenous clomipramine hydrochloride may be effective for patients with obsessive-compulsive disorder (OCD) who are nonresponsive to oral clomipramine.
Methods Fifty-four patients with oral clomipramine-refractory OCD were randomized to receive 14 infusions of either placebo or clomipramine hydrochloride, starting at 25 mg/d and increasing to 250 mg/d. Ratings were conducted double-blind after infusion 14 among 54 patients, single-blind 1 week later among 39 patients, and nonblind 1 month later among 31 patients. Response was based on a Clinical Global Impressions rating of at least "much improved."
Results Six (21%) of 29 patients randomized to receive intravenous (IV) clomipramine vs 0 of 25 patients given IV placebo were responders after 14 infusions (df=1, P<.02). Dimensional ratings after infusion 14 revealed significant (P=.007) improvement on the National Institute of Mental Health–Obsessive-Compulsive Scale and the Clinical Global Impressions Scale (P=.03), but not the Yale-Brown Obsessive Compulsive Scale. One week later, all dimensional measures of OCD showed significant improvement. At 1 week post-IV, 9 (43%) of 21 patients initially randomized to IV clomipramine and treated subsequently with oral clomipramine were responders, whereas 0 of 18 patients initially randomized to receive IV placebo and treated subsequently with several days of open-label IV clomipramine responded (df=1, P<.002). Of the 31 patients assessed 1 month after IV infusion (treatment not controlled), 18 (58.1%) were responders. Intravenous clomipramine treatment was safe with no serious adverse consequences.
Conclusions Intravenous clomipramine is more effective than IV placebo for patients with OCD with a history of inadequate response or intolerance to oral clomipramine. Further study of this promising treatment for refractory OCD is needed.
From the Department of Psychiatry, Columbia University and the Divison of Therapeutics of the New York State Psychiatric Institute, New York.
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