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Re: Interesting study on nortriptyline use in OCD

Posted by linkadge on September 16, 2010, at 6:34:02

In reply to Interesting study on nortriptyline use in OCD, posted by Conundrum on September 15, 2010, at 22:05:47

Yes, very interesting,

But I'm not sure if I buy the noradrenrgic theory for the augmentation.

Clomipramine has a metabolite which is a potent, selective NRI. So, its not as if clomipramine is an SSRI.

Another thing to consider, is that the clomipramine + nortriptyline group was on more drug. Was the improved efficacy simply to to more drug in the system?

It would have been more telling to add a third arm say:

clomipramine 150mg vs
clom 150 + nort 50mg vs
clom 200mg

or even

clom 150 + escitalopram 5mg

That way you would be able to pin the actions down to nortriptyline itself.

After that though, you need to consider other mechanisms of nortriptyline which might benefit ocd, i.e. 5-ht2 antagonism, sedative effects, opioid action?

Linkadge



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