To examine the efficacy and tolerability of clomipramine compared with the selective serotonin reuptake inhibitors (SSRIs) in the treatment of obsessive–compulsive disorder (OCD), bearing in mind the recent Expert Consensus Guidelines recommendation to use clomipramine after 2 to 3 failed SSRI trials.
Method:
The literature on the pharmacotherapy of OCD was critically examined.
Results:
The available research evidence is not conclusive but suggests that clomipramine possesses greater antiobsessional efficacy than do the SSRIs. In addition, when clomipramine is presented to patients in a positive way, and properly used in small initial doses with gradual increases, it seems to be tolerated as well as the SSRIs.
Conclusion:
Recently expressed opinions that clomipramine should be used to treat OCD after 2 to 3 failed SSRI trials are not supported by research evidence. Both clomipramine and the SSRIs may be used as first-line treatments for OCD.
GreistJHJeffersonJWKobakKAKatzelnikDJSerlinRC. Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder: A meta-analysis. Arch Gen Psychiatry1995;52:53–60.
5.
SteinDJSpadacciniEHollanderE. Meta-analysis of pharmacotherapy trials for obsessive-compulsive disorder. Int Clin Psychopharmacol1995;10:11–8.
6.
PiccinelliMPiniSBellantuonoCWillkinsonG. Efficacy of drug treatment in obsessive-compulsive disorder: A meta-analytic review. Br J Psychiatry1995;166:424–43.
7.
CoxBJSwinsonRPMorrisonBLeePS. Clomipramine, fluoxetine, and behaviour therapy in the treatment of obsessive-compulsive disorder: A meta-analysis. J Behav Ther Exp Psychiatry1993;24:149–53.
8.
BisserbeJCLaneRM, Flament MF, and the Franco-Belgian OCD Study Group. A double-blind comparison of sertraline and clomipramine in outpatients with obsessive-compulsive disorder. J Assn Eur Psychiatrists1997;12:82–93.
9.
RasmussenSA. The Meta-analytic Saga of Serotonin Reuptake Inhibitors in an Obsessional Word. CNS Spectrums, 1996;1,2:9
10.
PigottTAPatoMTBernsteinSEGroverGNHillJL, Tolliver TJ, and others. Controlled comparisons of clomipramine and fluoxetine in the treatment of obsessive-compulsive disorder. Arch Gen Psychiatry1990;47:926–32.
11.
Lopez-IborJJrSaizJCottrauxJNoteYViñasR, Bourgeois M, and others. Double-blind comparison of fluoxetine versus clomipramine in the treatment of obsessive-compulsive disorder. Eur Neuropsychopharmacol1996;6:111–8
12.
TodorovCBrassardMFontaineRVezinaMElieR. Fluoxetine versus clomipramine in obsessive-compulsive disorder. Tenth World Congress of Psychiatry; 1996 August 23–28; Madrid. Abstracts 2:296.
13.
SmeraldiEErzegovesiSBianchiYPasqualiLGocchiSRonchiP. Fluvoxamine vs clomopramine treatment in obsessive- compulsive disorder: A preliminary study. New Trends Exp Clin Psychiatry. 1992;8:63–5.
14.
FreemanCTrimbleMRDeakinJFWStokesTMAshfordJJ. Fluvoxamine versus Clomipramine in the treatment of obsessive-compulsive disorder: A multicenter, randomized, double-blind, parallel group comparison. J Clin Psychiatry1994;55:301–5.
15.
KoranLMMcElroySLDavidsonJRTRasmussenSAHollanderEJenikeMA. Fluvoxamine versus clomipramine for obsessive-compulsive disorder: A double-blind comparison. J Clin Psychopharmacol1996;16:121–9.
16.
KellyA. Selecting a serotonin reuptake inhibitor for obsessive-compulsive disorder. CNS Spectrums1996;1:32–8.
17.
Zohar J, Judge R, and the OCD Paroxetine Study Investigators. Paroxetine versus clomipramine in the treatment of obsessive-compulsive disorder. Br J Psychiatry1996;169:468–74.
18.
LeonardHL. New developments in the treatment of Obsessive-Compulsive Disorder. J Clin Psychiatry, 1997;58Suppl 14:39S–45S.
19.
GreistJChouinardGDuboffEHalarisAKimSW, Koran L, and others. Double-blind parallel comparison of three dosages of sertraline and placebo in outpatients with obsessive-compulsive disorder. Arch Gen Psychiatry1995;52:289–95.
20.
MavissakalianMRJonesBOlsonS. Absence of placebo response in obsessive-compulsive disorder. J Nerv Ment Dis1990;4:268–70.
21.
Clomipramine in the treatment of patients with obsessive-compulsive disorder. The Clomipramine Collaborative Study Group. Arch Gen Psychiatry1991;48:730–8.
22.
PigottTA. OCD: Where the serotonin selectivity story begins. J Clin Psychiatry1996;57Suppl: 11S–20S.
23.
StraussJLCavanaughS. Placebo effects: Issues for clinical practice in psychiatry and medicine. Psychosomatics1996;37:315–26.
24.
StahlSM. Not so selective serotonin uptake inhibitors. J Clin Psychiatry1998;59:343–4.
25.
MurphyDLAndrewsAMWichemsCHQianLMichihisaTGreenbergB. Brain serotonin neurotransmission: An overview and update with an emphasis on serotonin subsystem heterogeneity, multiple receptors, interactions with other neurotransmitter systems and consequent implications for understanding the actions of serotonergic drugs. J Clin Psychiatry1998;59Suppl 15: 4–12.
26.
TrindadeEMenonD. Selective serotonin reuptake inhibitors SSRIs) for major depression. Part I. Evaluation of the clinical literature. Ottawa: Canadian Coordinating Office for Health Technology Assessment; 1997. Aug. Report 3E.
