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Dr. Bob is Robert Hsiung, MD,
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Posted by Conundrum on September 15, 2010, at 22:05:47
http://www.ncbi.nlm.nih.gov/pubmed/9786103
Combination of clomipramine and nortriptyline in the treatment of obsessive-compulsive disorder: a double-blind, placebo-controlled trial.
Noorbala AA, Hosseini SH, Mohammadi MR, Akhondzadeh S.Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Iran.
Abstract
OBJECTIVE: There is growing interest in investigating noradrenergic functions in obsessive-compulsive disorder (OCD) because some antidepressants with strong effects on serotonin reuptake blockade fail to relieve obsessive-compulsive symptoms. We undertook a trial to investigate whether the combination of clomipramine with nortriptyline was more effective than clomipramine alone.METHOD: Thirty patients who met the DSM-IV criteria for OCD completed the study. Patients were allocated in a random fashion, 15 each to clomipramine 150 mg/ day plus nortriptyline 50 mg/day and clomipramine 150 mg/day plus placebo.
RESULTS: Although both protocols significantly decreased the scores of the Yale-Brown obsessive-compulsive scale over the trial period, the combination of clomipramine and nortriptyline showed a significant superiority over clomipramine alone in the treatment of OCD.
CONCLUSION: As this study indicates, a rapid onset of action is one of the advantages of this combination. This study supports further investigation of the noradrenergic-serotonergic hypothesis in OCD.
PMID: 9786103 [PubMed - indexed for MEDLINE]
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 200mgor 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
Posted by ed_uk2010 on September 16, 2010, at 13:54:30
In reply to Re: Interesting study on nortriptyline use in OCD, posted by linkadge on September 16, 2010, at 6:34:02
>After that though, you need to consider other mechanisms of nortriptyline which might benefit ocd, i.e. 5-ht2 antagonism, sedative effects, opioid action?
Or a pharmacokinetic interaction with clomipramine.
Posted by Conundrum on September 16, 2010, at 13:59:24
In reply to Re: Interesting study on nortriptyline use in OCD » linkadge, posted by ed_uk2010 on September 16, 2010, at 13:54:30
I have trouble trying to surrender and leave everything to random chance. I guess that is the way it is though. Perhaps I'm a bit obsessive.
Posted by Roslynn on September 16, 2010, at 15:24:24
In reply to Interesting study on nortriptyline use in OCD, posted by Conundrum on September 15, 2010, at 22:05:47
Conundrum,
Thank you for posting this. Interesting because I have been thinking of asking my pdoc to add just the smallest amount of nortriptyline to my clomipramine.
I'm not sure if he'd go for it though--I'm also on Prozac. Too many antidepressants?
Roslynn
Posted by Conundrum on September 16, 2010, at 15:29:18
In reply to Re: Interesting study on nortriptyline use in OCD, posted by Roslynn on September 16, 2010, at 15:24:24
There aren't too many unless they're all doing something for you.
Posted by ed_uk2010 on September 16, 2010, at 16:05:49
In reply to Re: Interesting study on nortriptyline use in OCD, posted by Roslynn on September 16, 2010, at 15:24:24
>Too many antidepressants?
No, I don't think it's a good idea. I think you risk toxicity rather than benefit.
Posted by Conundrum on September 16, 2010, at 16:08:00
In reply to Re: Interesting study on nortriptyline use in OCD » Roslynn, posted by ed_uk2010 on September 16, 2010, at 16:05:49
Yeh Ed has a good point. Prozac will increase level of both drugs, I don't know what nortriptyline what nortripyline does in the liver, but it probably would mean too high levels at normal doses.
Posted by Roslynn on September 16, 2010, at 19:12:30
In reply to Re: Interesting study on nortriptyline use in OCD » ed_uk2010, posted by Conundrum on September 16, 2010, at 16:08:00
Thank you Conundrum and Ed for your feedback on this!
Roslynn
This is the end of the thread.
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