Sept. 23, 2002 — In an open trial reported in the September issue of the Journal of Clinical Psychiatry, citalopram given intravenously was safe and rapidly effective in treating patients with refractory obsessive compulsive disorder (OCD). A placebo-controlled, double-blind trial of this selective serotonin reuptake inhibitor (SSRI) is now indicated.
"The early onset of response suggests a means of accelerating OCD symptom relief and predicting response to oral citalopram treatment," write Stefano Pallanti, MD, from the Istituto di Neuroscienze in Florence, Italy, and colleagues.
In this open-label trial, 39 adult outpatients received intravenous citalopram administered daily for 21 days, followed by oral citalopram until treatment day 84. All subjects had moderate-to severe DSM-IV OCD of one year's duration and had failed at least two trials of oral SSRIs excluding citalopram. Initial dose of intravenous citalopram was 20 mg/day, titrated upward to 40-80 mg/day as tolerated. Dropout rate was 2.6%.
After three weeks of intravenous treatment, 23 (59%) of patients had decreases in Yale-Brown Obsessive Compulsive Scale of at least 25%, including four patients (10%) with decreases of at least 35%. Decreases of at least 20% were seen in 27 patients (69%), all of whom continued on treatment with oral citalopram and had substantial further improvement by day 84, including significant improvement in several dimensions of quality of life.
"The benefits of intravenous treatment can be maintained and extended by subsequent treatment with oral citalopram," the authors write. "A double-blind, double-dummy design that compares intravenous citalopram, oral citalopram, and intravenous and oral placebo in treatment-resistant OCD is warranted."
J Clin Psychiatry. 2002;63(9):796-801
Reviewed by Gary D. Vogin, MD
