Zeitschrift für Depression und Angst

Zeitschrift für Depression und Angst
Offener Zugang

ISSN: 2167-1044


Citalopram Pulse-Loading for Severe Treatment-Resistant OCD: A Case Series of Acute Response, One Year Follow-Up and Tolerability

Giacomo Grassi and Stefano Pallanti

Background: Treatment resistance is a frequent situation in Obsessive Compulsive Disorder (OCD), occurring in 40-60% of patients. However, in the current literature there are only a few evidence-based options for treatmentresistant patients. Pulse-loading treatment consists in a rapid titration of the pharmacological agent in the first days of treatment. A few studies suggested that this kind of titration with intravenous clomipramine could result in a greater and faster response than with a standard titration in OCD resistant patients. The main aim of this case series was to investigate the effectiveness and tolerability of a citalopram pulse-loading protocol in severe treatment-resistant OCD patients. Methods: We treated 5 severe treatment-resistant OCD patients with intravenous citalopram starting with 40 mg for 3 days and increasing the dose up to 80 mg from the fourth day. The patients continued the treatment with 80 mgof intravenous citalopram for 18 days (a total of 21 days of intravenous treatment), then they switched to oral treatment (80 mg of oral citalopram). We assessed acute and one-year follow-up efficacy and tolerability.
Results: During the pulse-loading treatment no patients showed significant adverse events. Two of five patients had a full response and one of these had remission. Furthermore, these two patients did not have any relapse of OC symptoms during the 1-year follow-up. One of five patients had a partial response after 12 weeks and a full response during the 1-year follow-up period after switching from quetiapine to aripiprazole and after a CBT trial. Two of five patients did not respond. No patients showed clinical significant changes of the QTc interval. No patients showed significant changes of the sodium levels.
Conclusion: Taking into account the very limited sample size, this case series suggests that this treatment approach deserves further controlled studies.