Intravenous Clomipramine for Treatment-Resistant Obsessive-Compulsive Disorder

BACKGROUND: This open trial was conducted to evaluate the effectiveness of intravenous clomipramine (CMI) in refractory obsessive-compulsive disorder (OCD). METHODS: Thirty OCD poor responders to previous multiple trials of anti-obsessive medications were selected and admitted to the hospital. Severity of the illness and response to treatment were primarily assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). CMI was gradually administered intravenously for one week. All patients were thereafter switched to oral CMI with a maximum dose of 225mg/day. RESULTS: The Y-BOCS total score mean at admission was in the severe range (24–31), and dropped on discharge and follow-ups to the moderate range (16–23). At discharge, 23 patients (76.7%) had a decrease in Y-BOCS ≥25% and were considered responders, while only 18 (60%) were still responders at 24 weeks. No relevant persistent side effects were reported. CONCLUSION: Intravenous clomipramine could be of benefit for severe OCD cases that have not adequately responded to several therapies, including oral clomipramine.