Am J Psychiatry 1997; 154:396-401
Copyright © 1997 by American Psychiatric Association
Rapid benefit of intravenous pulse loading of clomipramine in obsessive- compulsive disorder
LM Koran, FR Sallee and S Pallanti
Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, CA 94305, USA.
OBJECTIVE: The authors conducted a randomized, double-blind, placebo-
controlled trial of intravenous versus oral pulse loading of clomipramine
in patients with obsessive-compulsive disorder to test two hypotheses: 1)
intravenous pulse loading will cause greater immediate improvement than
oral pulse loading and 2) patients who respond to pulse loading will
continue to improve during 8 weeks of oral clomipramine treatment. METHOD:
Fifteen patients with DSM-III-R obsessive-compulsive disorder of at least 1
year's duration and baseline Yale-Brown Obsessive Compulsive Scale scores
of 17 or higher were enrolled in the study. Yale-Brown scale ratings were
made 4.5 days after double-blind oral or intravenous pulse loading of
clomipramine, and patients were then given 150 mg/day of oral clomipramine
with increases of 25 mg every 4 days to 250 mg/day as tolerated or, in two
cases, other selective serotonin reuptake inhibitors (SSRIs). RESULTS: The
first hypothesis was confirmed: 4.5 days after the second pulse- loaded
dose, six of seven patients given intravenous clomipramine but only one of
eight given oral medication responded to the drug. After 8 weeks of oral
clomipramine, the results partially supported the second hypothesis: four
of six patients who had responded to intravenous clomipramine continued
their improvement, but those who had responded to pulse loading did not
improve statistically significantly more than those who had not.
CONCLUSIONS: Intravenous pulse loading of clomipramine may be a valuable
new treatment for obsessive-compulsive disorder, particularly for patients
who have failed oral treatment trials.
