OBJECTIVE: Clomipramine, a serotonin reuptake blocker that has unique
antiobsessional properties, was hypothesized to have a different effect
from that of desipramine, a tricyclic antidepressant with selective
adrenergic effects, for the stereotyped, repetitive behaviors in autism.
METHOD: Seven subjects, ages 6-18 years, with autistic disorder completed a
10-week double-blind, crossover trial of clomipramine and desipramine
following a 2-week single-blind, placebo phase. RESULTS: Clomipramine was
superior to desipramine and placebo, as indicated by standardized ratings
of autism and anger as well as ratings of repetitive and compulsive
behaviors. Clomipramine and desipramine were equally superior to placebo
for ratings of hyperactivity. Parents of all seven subjects elected to have
their children continue to take clomipramine after the study. CONCLUSIONS:
Clomipramine and desipramine are differentially effective in treating the
obsessive-compulsive and core symptoms in autistic disorder. Biological
links between compulsions and stereotyped, repetitive behaviors in autistic
disorder should be explored.