RAPID BENEFIT OF INTRAVENOUS PULSE LOADING OF CLOMIPRAMINE IN OBSESSIVE-COMPULSIVE DISORDER

Objective: The authors conducted a randomized, double-blind, placebo-c ontrolled trial of intravenous versus oral pulse loading of clomiprami ne in patients with obsessive-compulsive disorder to test two hypothes es: 1) intravenous pulse lending will cause greater immediate improvem ent than oval pulse loading and 2) patients who respond to pulse loani ng will continue to improve during 8 weeks of oral clomipramine treatm ent. Method: Fifteen patients with DSM-III-R obsessive-compulsive diso rder of at least 1 year's duration and baseline Yale-Brown Obsessive C ompulsive Scale scores of 17 or higher were enrolled in the study. Yal e-Brown scale ratings were made 4.5 days after double-blind oral or in travenous pulse loading of clomipramine, and patients were then given 150 mg/day of oral clomipramine with increases of 25 mg every 4 days t o 250 mg/day as tolerated or, in two cases, other selective serotonin reuptake inhibitors (SSRIs). Results: The first hypothesis was confirm ed: 4.5 clays after the second pulse-loaded dose, six of seven patient s given intravenous clomipramine but only one of eight given oral medi cation responded to the drug. After 8 weeks of oral clomipramine, the results partially supported the second hypothesis: four of six patient s who had responded to intravenous clomipramine continued their improv ement, but those who had responded to pulse loading did not improve st atistically significantly move than those who had not. Conclusions: In travenous pulse loading of clomipramine may be a valuable new treatmen t for obsessive-compulsive disorder, particularly for patients who hav e failed oral treatment trials.