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Uso de citalopram para trastorno obsesivo-compulsivo resistente al tratamiento

Published online by Cambridge University Press:  12 May 2020

S. Pallanti ,
L. Quercioli ,
R.S. Paiva  and
L.M. Koran
S. Pallanti
Affiliation:
Instituto de Neurociencia y Escuela Médica Universitaria de Florencia, Florencia
L. Quercioli
Affiliation:
Instituto de Neurociencia de Florencia, Florencia, Italia
R.S. Paiva
Affiliation:
Instituto de Neurociencia de Florencia, Florencia, Italia
L.M. Koran
Affiliation:
Departamento de Psiquiatría, Centro Médico Stanford, Stanford, CA, EE.UU
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Resumen

Hemos investigado la eficacia comparativa del citalopram frente a citalopram administrado con clomipramina en trastorno obsesivo-compulsivo (OCD) resistente al tratamiento. Dieciséis pacientes ambulatorios adultos participaron en un ensayo abierto distribuido al azar de 90 días. Los pacientes elegibles tenían de 18 a 45 años, OCD del DSM-III-R de moderado a grave de un año o más de duración, una puntuación de línea de base en la escala de Yale-Brown (Y-BOCS) de 25 o más y ningún otro diagnóstico activo del eje I, y habían tenido fracasos en ensayos adecuados de clomipramina y fluoxetina. El grupo de citalopram más clomipramina (n = 9) experimentó una disminución de porcentaje significativamente mayor en la puntuación media de la Y-BOCS para el día 90 que el grupo de citalopram solo (n = 7). Unicamente una paciente de citalopram disminuyó su puntuación en 35% o más, y dos en 25% o más. Los nueve pacientes de citalopram más clomipramina experimentaron disminuciones de 35% o más. Los efectos secundarios fueron de leves a moderados en ambos grupos. También tratamos con citalopram a seis pacientes de OCD que no habían tolerado la fluoxetina y la clomipramina solas; tres lograron disminuciones de la puntuación de la Y-BOCS de 35% o más a los 90 días. Puesto que el citalopram no afecta significativamente al metabolismo de la clomipramina, es poco probable que la mejoría en el grupo de combinación de medicamentos se haya derivado de mayores niveles de clomipramina en plasma. Se precisan ensayos controlados doble ciego de citalopram en OCD y de combinación de citalopram con clomipramina en OCD resistente al tratamiento.

Keywords

citalopramtratamiento combinadotrastorno obsesivo-compulsivoresistente al tratamiento
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 6 , Issue 7 , October 1999 , pp. 441 - 447
Copyright
Copyright © European Psychiatric Association 1999

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References

Bibliografía

Baettig, D, Bondolfi, G, Montaldi, S, Amey, M, Baumann, P.Tricyclic antidepresant plasma levels after augmentation with citalopram: a case study. Eur J Clin Pharmacol 1993; 44: 403–5.CrossRefGoogle Scholar
Bejerot, S, Humble, M.Citalopram treatment of OCD: a pilot study of anti-obssessive efficacy. Biol Psychiatry 1991; 29: 443–7.Google Scholar
Brosen, K.The pharmacogenetics of the selective serotonin reuptake inhibitors. Clin Invest 1993; 71: 1002–9.CrossRefGoogle ScholarPubMed
Brosen, K, Skjelbo, E, Rasmussen, BB, Poulsen, HE, Loft, S.Fluvoxamine is a potent inhibitor of cytochrome P4501A2. Biochem Pharmacol 1993; 45: 1211–4.CrossRefGoogle ScholarPubMed
Browne, M, Hornm, E, Jones, TT.The benefits of clomipramine-fluoxetine combination in obssessive compulsive disorder. Can J Psychiatry 1993; 38: 242–3.CrossRefGoogle Scholar
Figueroa, Y, Rosenberg, DR, Birmaher, B, Keshavan, MS.Combination treatment with clomipramine and selective serotonin reuptake inhibitors for obssessive-compul-sive disorder in children and adolescents. J Child Adolescent Psychopharmacol 1998; 8: 61–7.CrossRefGoogle ScholarPubMed
Goodman, WK, McDougle, CJ, Price, LH.Pharmacotherapy of obsessive compulsive disorder. J Clin Psychiatry 1992; 53: Suppl 4: 29–37.Google ScholarPubMed
Goodman, WK, McDougle, CJ, Barr, LC, Aronson, SC, Price, LH.Biological approaches to treatment-resistant obsessive compulsive disorder. J Clin Psychiatry 1993; 54 Suppl 6: 16–26.Google Scholar
Goodman, WK, Price, LH, Rasmusen, SA, Mazure, C, Delgado, P, Heninger, GR, et al.The Yale-Brown Obessive Compulsive Scale I: development, use, and reliability. Arch Gen Psychiatry 1989; 46: 1006–11.CrossRefGoogle Scholar
Greist, JH, Jefferson, JW, Kobak, KA, Katzelnick, DJ, Serlin, RC.Efficacy and tolerability of serotonin transport inhibitors in obssessive-compulsive disorder. Arch Gen Psychiatry 1995; 52: 53–60.CrossRefGoogle Scholar
Greist, JH, Jefferson, JW, Kobak, KA, Chouinard, G, DuBoff, E, Halaris, A, et al.A1 year double-blind placebo-controlled fixed dose study of sertraline in the treatment of obsessive-compulsive disorder. Int Clin Psychopharmacol 1995; 10: 57–65.CrossRefGoogle Scholar
Guy, W.ECDEU Assessment Manual for Psychopharmacology. Washington DC: US Dept of Health, Education, and Welfare 1976; Publication No. 76–338.Google Scholar
Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23: 56–66.CrossRefGoogle ScholarPubMed
Hartter, S, Arand, M, Oesch, F, Hiemke, K.Non-competitive inhibition of clomipramine N-demethylation by fluvoxamine. Psychopharmacology 1995; 117: 149–53.CrossRefGoogle ScholarPubMed
Hyttel, J.Neurochemical characterization of a new potent and selective serotonin uptake inhibitor: Lu 10-171. Psychopharmacology 1977; 51: 225–33.CrossRefGoogle ScholarPubMed
Hyttel, J.Comparative pharmacology of SSRIs. Nord Psykiatr Tidsskr 1993; 47: Suppl 30: 5–12.CrossRefGoogle Scholar
Hyttel, J.Pharmacological characterization of selective serotonin re-uptake inhibitors (SSRIs). Int Clin Psychopharmacol 1994; 9: Suppl 1: 19–26.CrossRefGoogle Scholar
Hyttell, J, Bogeso, KP, Perregaard, J, Sánchez, C.The pharmacological effect of citalopram resides in the (S)-(+) enantiomer. J Neural Transm 1992; 88: 157–60.CrossRefGoogle Scholar
Hyttel, J, Larsen, JJ.Serotonin-selective antidepressants. Acta Pharmacol Toxicol 1985; 56 Suppl 1: 146–53.Google Scholar
Jenike, MA, Rauch, SL.Managing the patient with treatment-resistant obsessive compulsive disorder: current strategies. J Clin Psychiatry 1994; 55 Suppl 3: 11–7.Google Scholar
Jefferson, JW, Altemus, M, Jenike, MA, Pigott, TA, Stein, DJ.Algorithm for the treatment of obessive-compulsive disorder (OCD). Psychopharm Bull 1995; 31: 487–90.Google Scholar
Koponen, H, Lepóla, U, Leinonen, E, Jakinen, R, Penttinen, J, Turtonen, J.Citalopram in the treatment of obsessive compulsive disorder: An open pilot study. Acta Psychiatr Scand 1997; 96: 343–6.CrossRefGoogle Scholar
Koran, LM, Sallee, FR, Pattanti, S.Rapid benefit of intravenous pulse loading of clomipramine in obssessive-compulsive disorder. Am J Psychiatry 1997; 154: 396–401.Google Scholar
Leckman, JF, Riddle, MA, Hardin, MT, Ort, SI, Swartz, KL, Stevenson, J, et al.The Yale global Tic severity scale: initial testing of a clinician-rated scale or tic severity. J Am Acad Child Adolesc Psychiatry 1989; 28: 566–73.CrossRefGoogle ScholarPubMed
Lesch, KP, Hoh, A, Disselkamp-Tietze, J, Wiesmann, M, Osterheider, M, Schulte, HM.5-Hydroxytryptamine la receptor responsivity in obsessive-compulsive disorder. Arch Gen Psychiatry 1991; 48: 540–7.CrossRefGoogle Scholar
Madsen, H, Nielsen, KK, Brosen, K.Imipramine metabolism in relation to the sparteine and mephenytoin oxidation polymorphism - a population study. Br J Clin Pharmacol 1995; 39: 433–9.CrossRefGoogle ScholarPubMed
March, JS, Francés, A, Carpenter, D, Kahn, DA.The expert consensus guideline series: treatment of obsessive-compulsive disorder. J Clin Psychiatry 1997; Suppl 4: 1–72.Google Scholar
McDougle, CJ, Goodman, WK, Leckman, JF, Lee, NC, Heninger, GR, Price, LH.Haloperidol addition in fluvo-xamine-refractory obssessive-compulsive disorder. Arch Gen Psychiatry 1994; 51: 302–8.CrossRefGoogle Scholar
Mundo, E, Bianch, L, Bellodi, L.Efficacy of fluvoxamine, paroxetine, and citalopram in the treatment of obssessive-compulsive disorder: a single-blind study. J Clin Psychopharmacol 1997; 17: 267–71.CrossRefGoogle Scholar
Overo, FK.Preliminary studies of the kinetics of citalopram in man. Eur J Clin Pharmacol 1978; 14: 69–73.CrossRefGoogle ScholarPubMed
Overo, FK, Toft, B, Christophersen, L, Gylding-Sabroe, JP.Kinetics of citalopram in elderly patients. Psychopharmacology 1985; 86: 253–7.CrossRefGoogle Scholar
Pedersen, LO, Kragh-Sorensen, P, Bjerre, M, Overo, FK, Gram, LF.Citalopram, a selective serotonin re-uptake inhibitor: clinical antidepressive and long-term effect - a phase II study. Psychopharmacology 1982; 77: 199–204.CrossRefGoogle ScholarPubMed
Rasmussen, BB, Máenpaa, J, Pelkonen, O, Loft, S, Poulsen, HE, Lykkesfeldt, J, et al.Selective serotonin re-uptake inhibitors and theophylline metabolism in human liver microsomes: potent inhibition by fluvoxamine. Br J Clin Pharmacol 1995; 39: 151–9.CrossRefGoogle Scholar
Rauch, SL, O’Sullivan, RL, Jenike, MA.Open treatment of obsessive-compulsive disorder with venlafaxine: a series of ten cases. J Clin Psychopharmacol 1996; 16: 81–4.CrossRefGoogle ScholarPubMed
Ravizza, L, Barzega, G, Bellino, S, Bogetto, F, Maina, G.Therapeutic effect and safety of adjunctive risperidone in refractory obsessive-compulsive disorder (OCD). Psychophamacol Bull 1996; 32: 677–82.Google Scholar
Simeón, JG, Thatte, S, Wiggins, D.Treatment of adolescent obssessive-compulsive disorder with a clomipramine-fluoxetine combination. Psychopharmacol Bull 1990; 26: 285–90.Google Scholar
Sindrup, SH, Brosen, K, Hansen, MCJ, Aaes-Jörgensen, T, Overo, KF, Gram, LF.Pharmacokinetics of citalopram in relation to the sparteine and the mephenytoin oxidation polymorphisms. Ther Drug Monit 1993; 15: 11–7.CrossRefGoogle ScholarPubMed
Spitzer, RL, Williams, JBL, Gibbon, M, First, MB.Structured Clinical Interview for DSM-III-R-Personality Disorders (SCID-II, version 1.0). Whashington, DC: American Psychiatryc Press; 1990.Google Scholar
Spitzer, RL, Williams, JBL, Gibbon, M, First, MB.The Structured Clinical Interview for DSM-III-R (SCID), I: history, rationale, and description. Arch Gen Psychiatry 1992; 49: 624–9.CrossRefGoogle ScholarPubMed
Symes, MH.Cardiovascular effects of clomipramine (Anafranil). J Int Med Res 1973; 1: 460–3.CrossRefGoogle Scholar
Szegedi, A, Wetzel, H, Leal, M, Harter, S, Hiemke, C.Combination treatment with clomipramine and fluvoxamine: drug monitoring, safety, and tolerability data. J Clin Psychiatry 1996; 57: 257–64.Google ScholarPubMed
Thomsen, PH.Child and adolescent obsessive-compulsive disorder treated with citalopram: Findings from an open trial of 23 cases. J Child Adolesc Psychopharmacol 1997; 7: 157–66.CrossRefGoogle ScholarPubMed
Tollefson, GD, Birkett, M, Koran, L, Genduso, L.Continuation treatment of OCD: double-blind and-open-label experience with fluoxetine. J Clin Psychiatry 1994; 55 Suppl 10: 69–76.Google Scholar
Wade, AG, Lepóla, U, Koponen, HJ, Pedersen, V, Pedersen, T.The effect of citalopram in panic disorder. Br J Psychiatry 1997; 170: 549–53.CrossRefGoogle ScholarPubMed
White, K, Keck, PE, Lipinski, J.Serotonin-uptake inhibitors in obsessive-compulsive disorder: a case repon. Comp Psychiatry 1986; 27: 211–4.CrossRefGoogle Scholar
Zohar, J, Judge, R and the OCD Paroxetine Study Investigators. Paroxetine vs. clomipramine in the treatment of obssessive-compulsive disorder. Br J Psychiatry 1996; 169: 468–74.CrossRefGoogle Scholar