COMBINATION TREATMENT WITH CLOMIPRAMINE AND SELECTIVE SEROTONIN REUPTAKE INHIBITORS FOR OBSESSIVE-COMPULSIVE DISORDER IN CHILDREN AND ADOLESCENTS

Medication management of obsessive-compulsive disorder (OCD) has consi sted of monotherapy with either clomipramine (CMI) or selective seroto nin reuptake inhibitors (SSRIs) such as fluvoxamine, paroxetine, or se rtraline. Frequently, OCD patients receiving monotherapy experience lo w treatment response rates and problematic side effects that may resul t in discontinuation or noncompliance. This open-label case series pre sents 7 patients (6 male, 1 female) ages 9 to 23 years with OCD who we re effectively treated with combination of CMI plus an SSRI. Treatment effects persisted through 5 to 22 months of follow-up from onset of c ombination therapy. The drug combination was effective in the 2 patien ts with OCD and no mood/anxiety comorbidity. Side effects appeared in 5 of 7 patients; cardiovascular side effects were the most common adve rse effects. Two patients had prolongation of QTc intervals and 2 deve loped tachycardia while taking CMI and SSRI combinations. Other risks might include serotonin syndrome, manic switch, insomnia, and possibly headaches, FPS, and sexual dysfunction. Recommendations are made to m onitor electrocardiograms, CMI blood concentrations, and vital signs i n all cases because SSRIs can increase the blood levels of CMI and/or its active metabolite, desmethylclomipramine (DCMI). CMI could also po tentially increase SSRI absorption and/or protein binding. The use of CMI and SSRI combination therapy was found to be more effective compar ed with their monotherapy in all 7 cases.