Abstract
Forty-nine obsessive-compulsive ritualisers completed a double-blind controlled study of clomipramine and exposure therapy. More severely ill patients allowed higher doses of medication to be prescribed and had higher plasma levels of both clomipramine and desmethylclomipramine. Exposure instructions had a strong effect, whereas the clomipramine effect was small and short-lived. Plasma levels of desmethylclomipramine but not of clomipramine correlated with outcome at weeks 8 and 17. There was no evidence of a therapeutic window for either clomipramine or its metabolite. Patients' physical complaints before treatment correlated positively with depression and anxiety, especially sexual difficulties. Dry mouth, as a side effect, was most evidently related to clomipramine and its usefulness in monitoring drug compliance for patients on clomipramine is reaffirmed.
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Amin MN, Ban TA, Peckold JC, Kringler A (1977) Clomipramine and behaviour therapy in obsessive-compulsive and phobic disorders. J Int Med Res [Suppl 5] 5:33–37
Basoglu M, Lax T, Kasvikis YG, Marks IM (1987) Patterns and predictors of improvement in obsessive-compulsive disorder. J Anxiety Disorders
Beaumont G (1980) A large multicentre general practitioner's study of clomipramine in the treatment of agorophobia and social phobias. Pharm Med 1:85–91
Beck AT, Rial WY, Rickels K (1974) Short form of depression inventory: cross validation. Psychol Rep 34:1184–1186
Capstic N (1980) Contributions to the understanding of obsessional states and to the use of clomipramine in these conditions. Pharm Med 1:179–185
Cooper-Smart DJ, Rodham R (1973) A technique for surveying side effects of tricyclic drugs with reference to reported sexual effects. J Int Med Res 1:473–476
Dawling S, Braithwaite RA (1978) Simplified method for monitoring tricyclic antidepressant therapy using gas-liquid chromatography with nitrogen detection. J Chromatogr 146:449–456
Foa EB, Staketee G, Turner RM, Fisher SC (1980) Effects of imaginal exposure to feared disasters in obsessive-compulsive checkers. Behav Res Ther 18:449–455
Gelder MG, Marks IM (1966) Severe agorophobia: A controlled prospective trial of behaviour therapy. Br Psychiatry 112:309–319
Gram FL, Kragh-Sorensen P, Kristensen BC, Moller M, Pedersen LO, Thayssen P (1984) Plasma levels and monitoring of antidepressants. In: Usdin E (ed) Theoretical basis and clinical application in research in depression. Raven Press, New York
Hamilton M (1969) Standardised assessment and recording of depressive symptoms. Psychiatr Neurol Neurochirurg 72:201–205
Hollister L (1983) Clinical pharmacology of psychotherapeutic drugs, 2nd edn. Churchill Livingston
Laakman G, Gugath M, Kuss HJ, Zygan K (1984) Comparison of growth hormone and prolactin stimulation induced by clomipramine and desimpramine in man in connection with clomipramine metabolism. Psychopharmacology 82:62–67
Marks IM (1983) Are there anti-obsessive or anti-phobic drugs? Review of the evidence. Br J Psychiatry 143:338–347
Marks IM, Hodgon R, Rachman S (1975) Treatment of chronic obsessive compulsive neurosis by in vivo exposure. A two year follow up and issues in treatment. Br J Psychiatry 127:349–364
Marks IM, Stern RS, Mawson D, Cobb J, McDonald R (1980) Clomipramine and exposure for obsessive compulsive rituals, I. Br J Psychiatry 196:1–25
Marks IM, Lelliot P, Basoglu M, Noshirvani H, Monteiro W, Cohen D, Kasvikis Y (1988) Clomipramine, self-exposure and therapist-aided exposure in obsessive-compulsive ritualisers. Br J Psychiatry (in press)
Mawson D, Marks IM, Ramm L (1982) Clomipramine and exposure for chronic obsessive compulsive rituals III: Two year follow up and further findings. Br J Psychiatry 140:11–18
Monteiro WO, Noshirvani HF, Marks IM, Lelliott PT (1987) Anorgasmia from clomipramine in obsessive compulsive disorder. Br J Psychiatry 151:107–112
Reisby N, Gram LF, Bech P, Sihm F, Krautwald O, Elley J, Ortmann J, Christiansen J (1979) Clomipramine plasma levels and clinical effects. Community Psychopharmacol 2:419–427
Snaith RP, Ahmed SN, Mehta S, Hamilton M (1971) Assessment of severity of primary depressive illness: Wakefield self assessment depression inventory. Psychol Med 1:143–149
Stern SR, Marks IM, Mawson D, Luskombe KD (1980) Clomipramine and exposure for compulsive rituals II: Plasma levels, side effects and outcome. Br J Psychiatry 196:161–166
Thoren P, Asberg M, Cronholm B, Jornestedt L, Traskman L (1980a) Clomipramine treatment of obsessive-compulsive disorder. I. A controlled clinical trial. Arch Gen Psychiatry 37:1281–1285
Thoren P, Asberg M, Bertilsson L, Mellstrom B, Sjoqvist F, Traskman L (1980b) Clomipramine treatment of obsessive compulsive disorder II: Biochemical aspects. Arch Gen Psychiatry 37:1289–1294
Traskman L, Asberg M, Bertilsson L, Cronholm B, Mellstrom B, Neckers L, Sjoqvist F, Thoren P, Tybring G (1979) Plasma levels of clomipramine and it's metabolite during treatment of depression. Differential biochemical and clinical effects of the two compounds. Clin Pharmacol Ther 26:600–610
Yaryura-Tombias AJ, Bhagavan HN (1977) L-Tryptophan in obsessive compulsive disorders. Am J Psychiatry 134:1298–1299
Yaryura-Tombias AJ, Neziroglu FA (1983) Obsessive compulsive disorders. Dekker, New York Basel
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Kasvikis, Y., Marks, I.M. Clomipramine in obsessive-compulsive ritualisers treated with exposure therapy: relations between dose, plasma levels, outcome and side effects. Psychopharmacology 95, 113–118 (1988). https://doi.org/10.1007/BF00212778
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DOI: https://doi.org/10.1007/BF00212778