Obsessive-compulsive disorder citalopram

A 19-year-old man with focal epilepsy took carbamazepine 1000 mg/day and lamotrigine 300 mg/day. Because his seizures persisted topiramate was added up to 200 mg/day and the dose of carbamazepine was reduced to 300 mg/day. Behavioral problems started within a week and worsened over the following months. He finally developed obsessive-compulsive disorder. Citalopram was given in doses up to 60 mg/ day and topiramate was tapered within 2 weeks. The symptoms improved. 

SSRIs are widely used for treatment of depression, as well as, for example, panic disorders and obsessive—compulsive disorder. These dmgs are well recognized as clinically effective antidepressants having an improved side-effect profile as compared to the TCAs and irreversible MAO inhibitors. Indeed, these dmgs lack the anticholinergic, cardiovascular, and sedative effects characteristic of TCAs. Their main adverse effects include nervousness /anxiety, nausea, diarrhea or constipation, insomnia, tremor, dizziness, headache, and sexual dysfunction. The most commonly prescribed SSRIs for depression are fluoxetine (31), fluvoxamine (32), sertraline (52), citalopram (53), and paroxetine (54). SSRIs together represent about one-fifth of total worldwide antidepressant unit sales. 

Citalopram, escitalopram, and paroxetine are not approved for use in pediatric patients. Fluoxetine is approved for use in pediatric patients with MDD and obsessive-compulsive disorder (OCD). Sertraline is not approved for use in pediatric patients except for patients with OCD. Fluvoxamine is not approved for use in pediatric patients except for patients with OCD. 

Due to the frequent unwanted effects and, in case of tranylcypromine, the numerous and dangerous interactions MAO-inhibitors are more and more replaced by the much less problematic SSRIs. Compounds belonging to this group are citalopram, escitalopram, fluoxetine, paroxetine and sertraline. They are used clinically in the therapy of depression, bulimia and obsessive-compulsive disorders. All SSRIs show a slow onset of action (1-2 weeks). They may induce insomnia and weight loss. The antidepressant ven-lafaxine inhibits both, serotonin and noradrenaline re-uptake and might therefore additionally induce hypertension. 

In 1987, the FDA approved the drug fluoxetine (Prozac) for use in the treatment of major depression. Fluoxetine belongs to a class of agents referred to as selective serotonin reuptake inhibitors (SSRIs). The SSRIs now include sertraline (Zoloft), fiuvoxamine (Luvox), paroxetine (Paxil), and citalopram (Celexa). Fiuvoxamine is approved for use only in obsessive-compulsive disorder and is not discussed in this chapter. 

FIGURE 39.2 Treatment algorithm for pediatric obsessive-compulsive disorder (OCD). In adjusting cognitive behavior therapy (CBT), increase frequency or intensity, or alter the setting or format, e.g., have it be home based or day treatment. CMI, clomipramine DMI, desipramine NT, nortriptyline SSRI, selective serotonin reuptake inhibitor (fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram). 

Thompson, P.H. (1997) Child and adolescent obsessive-compulsive disorder treated with citalopram findings from an open trial of 23 cases. / Child Adolesc Psychopharmacol 7 157-166. 

Note. BROF = brofaromine CIT = citalopram CLO = clomipramine CT = cognitive therapy Dx = diagnosis EXP = exposure in vivo FLU = fluvoxamine FLUOX = fluoxetine GAD = generalized anxiety disorder 5-HTP = 5-hydrox3rtryptophan IMl = imipramine MAP = maprotiline OCD = obsessive-compulsive disorder PAR = paroxetine PD = panic disorder PLA = placebo PPM = psychological panic management RIT = ritanserin ... 

Zimelidine was the first serotonin reuptake inhibitor available for clinical use, but in 1982 was withdrawn worldwide because of its toxicity ( 110). Despite this initial setback, five members of this class have been marketed in the United States and various countries around the world citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft). All except fluvoxamine have marketed indications in the United States for the treatment of major depression. Fluvoxamine is marketed in the United States for the treatment of obsessive-compulsive disorder rather than major depression, although it is marketed in a number of other countries for major depression. 

Pato MT. Beyond depression citalopram for obsessive-compulsive disorder. Int Clin Psychopharmacol 1999 14[Suppl 2] S19-S26. 

Koponen H, LepolaU, Leinonen E, Jokinen R, Penttinen J, Turtonen J (1997) Citalopram in the treatment of obsessive-compulsive disorder an open pilot study. Acta Psychiatr Scand 96 343-346... 

Mundo E, Bianchi L, Bellodi L. Efficacy of fluvoxamine, paroxetine, and citalopram in the treatment of obsessive-compulsive disorder. J Qin Psychopharmacol 1997 17 267-271. 

Pallanti S, Quercioli L, Paiva RS, Koran LM. Citalopram for treatment-resistant obsessive-compulsive disorder. Em Psychiatry 1999 14 101-106. 

Pallanti S, Quercioli L, Bruscoli M. Response acceleration with mirtazapine augmentation of citalopram in obsessive compulsive disorder patients without comorbid depression a pilot study, j Clin Psychiatry 2004 65 1394-1399. 

The primary uses for the SSRIs include MMD and bipolar depression (fluoxetine, paroxetine, sertraline, and citalopram), atypical depression (i.e., depressed patients with unusual symptoms, e.g., hypersomnia, weight gain, and interpersonal rejection sensitivity fluoxetine, paroxetine, sertraline, and citalopram), anxiety disorders, panic disorder (sertraline and paroxetine), dysthymia, premenstrual syndrome, postpartum depression, dysphoria, bulimia nervosa (fluoxetine), obesity, borderline personality disorder, obsessive-compulsive disorder (fluvoxamine, fluoxetine, paroxetine, and sertraline), alcoholism, rheumatic pain, and migraine headache. Among the SSRIs, there are more similarities than differences however, the differences between the SSRIs could be clinically significant. 

When compared with the selective serotonin reuptake inhibitors (SSRIs), mirtazapine may show an earlier onset of action (although data are currently not well established). Mirtazapine has also been found to be efficacious in the treatment of elderly patients with depression. Mirtazapine has been shown to be effective in the treatment of panic disorder, social phobia, and post-traumatic stress disorder. In one study, mirtazapine combined with citalopram in obsessive-compulsive patients induced an earlier response when compared with citalopram plus placebo. It was suggested that antagonism of presynaptic a2-adrenergic receptors does not enhance serotonin neurotransmission directly, but rather disinhibits the norepinephrine activation of serotonergic neurons and thereby increases serotonergic neurotransmission by a mechanism that may not require a time-dependent desensitization of receptors. 

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