Intravenous Clomipramine for Treatment-Resistant Obsessive-Compulsive Disorder

Karameh, Wael K.; Khani, Munir

doi:10.1093/ijnp/pyv084

Cited by 9 publications

(4 citation statements)

References 17 publications

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“…In line with previous studies [36,37,38,39], we defined response to treatment at follow-up as a percentage decrease of at least 25% from baseline Y-BOCS in OCD patients and of at least 50% from baseline HAM-D in MDD patients.…”

Section: Methodsmentioning

confidence: 99%

Serum Levels of Insulin-Like Growth Factor-1 and Obsessive-Compulsive Disorder: A Case-Control Study

et al. 2016

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Background/Aims: Recent findings suggest an involvement of insulin-like growth factor-1 (IGF-1) in the pathogenesis of many psychiatric disorders; however, there is a lack of data regarding IGF-1 in patients with obsessive-compulsive disorder (OCD). The aims of the present study were (1) to analyze putative alterations of IGF-1 serum content in patients with OCD compared to patients with major depressive disorder (MDD) and healthy controls, and (2) to analyze putative changes of IGF-1 levels during drug treatment in subjects with OCD compared to patients with MDD. Methods: We recruited 40 OCD patients, 37 MDD patients, and 43 healthy controls. All participants were adults. Serum IGF-1 levels were measured by the ELISA method on venous blood samples collected at baseline and after 10 ± 1 weeks of drug treatment. Results: IGF-1 levels were increased in OCD patients compared to controls (149.9 ± 60.2 vs. 121.2 ± 51.6 ng/ml; p = 0.040). No correlations were observed between baseline IGF-1 levels, clinical features, and response to treatment at follow-up in OCD or MDD patients. No changes in serum IGF-1 were observed after drug treatment. Conclusion: Our results show for the first time that serum IGF-1 levels are altered in patients with OCD. Further research on the role of IGF-1 in OCD is warranted.

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Section: Methodsmentioning

confidence: 99%

Serum Levels of Insulin-Like Growth Factor-1 and Obsessive-Compulsive Disorder: A Case-Control Study

et al. 2016

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“…Clomipramine, a TCA, acts as a prefer ential inhibitor of 5hydroxytryptamine uptake and has proven effective in man aging depression, TRD, and obsessive compulsive disorder (OCD). 67 Although this medication has reported treatment benefits for patients with phobia, panic disorder, 15…”

Section: Clomipraminementioning

confidence: 99%

“…A protocol with a 50 mg/d starting dose and titration up to a maximum dose of 225 mg/d over 5 to 7 days has been sug gested for inpatient settings. 67 Titration to 250 mg is more common. 80 A longer series may be performed, but this increases the likelihood of adverse effects.…”

Section: Interventional Psychiatrymentioning

confidence: 99%

Interventional psychiatry (Part 1)

Arbuck¹

2023

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A dvances in the understanding of neurobiological and neuro psychiatric pathophysiology have opened new avenues of treatment for psychiatric patients. Historically, with a few exceptions, most psychiatric medications have been administered orally. However, many of the newer treatments require some form of special ized administration because they cannot be taken orally due to their chemical property (such as aducanumab); because there is the need to produce stable blood levels of the medication (such as brexanolone); because oral administration greatly diminished efficacy (such as oral vs IV magnesium or scopolamine), or because the treatment is focused on specific brain structures. This need for specialized administration has created a subspecialty called interventional psychiatry.Part 1 of this 2part article provides an overview of 1 type of inter ventional psychiatry: parenterally administered medications, includ ing those administered via IV. We also describe 3 other interventional approaches to treatment: stellate ganglion blocks, glabellar botulinum toxin (BT) injections, and trigger point injections. In Part 2 we will review interventional approaches that involve neuromodulation. Parenteral medications in psychiatryIn general, IV and IM medications can be more potent that oral medica tions due to their overall faster onset of action and higher blood con centrations. These more invasive forms of administration can have significant limitations, such as a risk of infection at the injection site, the need to be administered in a medical setting, additional time, and patient discomfort.

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“…In a double-blind controlled trial of IV compared with orally administered clomipramine over a 12-week treatment, pulse-loaded IV did not induce a greater Y-BOCS score reduction in treatment-resistant OCD [35]. Another open-label trial was performed to assess the efficacy of IV administered clomipramine in treatment-resistant OCD, and reported that IV route could be beneficial for patients with severe OCD that is unresponsive to several therapies, including orally administered clomipramine [36]. Other non-pharmacological treatment options are currently under evaluation, including deep brain stimulation (DBS).…”

Section: Treatment Approachesmentioning

confidence: 99%

Pharmacotherapy for treatment-respondent vs. refractory obsessive–compulsive disorder in children and adults: strategies, meta-analyses and clinical guidelines

Sayah¹,

Rahim²

2018

Arch Psych Psych

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Obsessive-compulsive disorder (OCD) is a common mental health disorder that occurs at all ages, but more commonly in younger people. It affects 1-1.5% of the general population. Many pharmacological therapies have been reported to diminish OCD symptoms, as well as increase the patient's quality of life. So far, several meta-analyses have directly compared such treatment approaches in treatment-responsive and treatmentresistant OCD. This review evaluated all treatment options for OCD in both children and adolescents, and aimed to establish whether existing pharmacological therapies work similarly well, taking into account medical comorbidities such as substance use, anxiety, metabolic disorders, and finally, an overview of issues related to safety and monitoring. Our review included data from 16 meta-analyses and 8 practical guidelines focusing on OCD patients. In adults with OCD, we found that combined therapy shows favorable outcomes versus SRI alone and produced better results. In children with OCD the greatest incremental treatment gains occur early in treatment with selective serotonin reuptake inhibitors (SSRIs). Finally, in treatment-resistant OCD augmentation of SRIs can be regarded as an evidence-based measure in pharmacological therapy. The results of this review mostly support the previous reviews on the pharmacological management of OCD. However, we noted that combination/augmentation of SSRIs significantly improved symptoms in treatment-resistant OCD compared with monotherapy. From a clinical perspective, antipsychotics combination/augmentation of SSRIs should be used in comorbid psychosis, a frequent comorbidity in OCD, especially as the presence of comorbidities is highly associated with treatment resistance in OCD.

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Intravenous Clomipramine for Treatment-Resistant Obsessive-Compulsive Disorder

Cited by 9 publications

References 17 publications

Serum Levels of Insulin-Like Growth Factor-1 and Obsessive-Compulsive Disorder: A Case-Control Study

Serum Levels of Insulin-Like Growth Factor-1 and Obsessive-Compulsive Disorder: A Case-Control Study

Interventional psychiatry (Part 1)

Pharmacotherapy for treatment-respondent vs. refractory obsessive–compulsive disorder in children and adults: strategies, meta-analyses and clinical guidelines

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