Combination of citalopram and nortriptyline in the treatment of obsessive-compulsive disorder: a double - blind, placebo-controlled trial

ABSTRACT

The fact that some antidepressants with strong effects on serotonin reuptake blockade fail to relieve obsessive-compulsive symptoms has caused growing interest in investigating noradrenergic function in obsessive-compulsive disorder [COD]. In light of the above, we undertook a trial to investigate whether the combination of citalopram with nortriptyline is more effective in treating obsessive compulsive symptoms than citalopram alone. 40 patients who met the DSM-IV criteria for COD were included in the study. Patients were allocated in a random fashion 20 patients to citalopram 40mg /day plus nortriptyline 50mg day, and 20 patients to citalopram 40mg /day plus placebo. Both protocols significantly decreased the scores of the Yale-Brown Obsessive Compulsive Scale [Y-BOCS] over the trial period, but the combination of citalopram and nortriptyline showed a significant superiority over citalopram alone in the treatment of COD. As this study indicates, nortriptyline improves the efficacy of citalopram. In addition, 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