[ comparison between fluoxetin and clomipramin in children and adolescents with obsessive - compulsive disorder]

ABSTRACT

Obsessive compulsive disorder [OCD] in children and adolescents is apparently a much more common disorder than what believed before. Most studies concerning treatment of OCD has been based on experience from adult patients. Only a few controlled trials using medication in children with OCD have been conducted. The present study compared the efficacy of clomipramin and fluoxetin in children and adolescents with OCD. This double blind clinical trial, performed from 2002 for one year, at Mashhad Pediatric Psychiatry, compared the efficacy of clomipramin and fluoxetin in 26 OCD children and adolescents, randomized into two groups. Efficacy assessments included the child version of Yale -Brown obsessive compulsive scale [CYBOCS] and NIMH Global rating scale and Maudsely questionnaire. The study took 8 weeks long and assessments were accomplished before the treatment, 4weeks and 8weeks after it. Clomipramin was used 10mg/day in patients over 20 kg weight and increased to 50 mg /day in one week. Dosage then rose up to 3 mg/kg based on the clinician's decision. Fluoxetin was started with 10 mg/day and reached 20 mg/day in one week. Then titrated up to 1mg/kg/day based on clinical judgment of clinician. Three patients were dropped out because of different reasons and one patient discontinued using Clomipramin because of its adverse effects. Data were collected and analyzed using the descriptive statistics and Mann withney test. There was a significant difference in the efficacy of the two drugs based on total CYBOCS score and the score of obsessions, compulsions and fluoxetine was more effective than clomipramin. However, there was no conciderable variation between them based on maudsely questionnaire, its subscales scores and NIMH Global rating scale score. The CYBOCS total score decreased to 44% and 49% after 8 weeks of clomipramin and fluoxetin consumption, respectively. The results suggested that fluoxetin is at least as effective as clomipramin in short term treatment of children and adolescents with OCD. More studies with larger sample size and longer time for follow-up are recommended