Simeon J G, Thatte S, Wiggins D
Royal Ottawa Hospital, Ontario, Canada.
Psychopharmacol Bull. 1990;26(3):285-90.
Clomipramine has been reported to be effective in the treatment of obsessive-compulsive disorder (OCD). Children and adolescents, however, tolerate poorly the adverse effects of tricyclics. Fluoxetine and other serotonin re-uptake inhibitors also appear useful in OCD, and are safer than clomipramine. To maximize the therapeutic effects and minimize adverse effects, 6 adolescents with OCD were treated in single trials with a clomipramine-fluoxetine combination. Duration of combined drug therapy ranged from 4 weeks to more than 28 weeks. Patients were first treated with clomipramine alone; if improvement or adverse effects were unsatisfactory, they received the drug combination. Clinical global improvement with clomipramine alone was moderate in 3 patients and minimal in 3. With a combined clomipramine-fluoxetine therapy, improvements were marked in 5 patients, and moderate in 1. These improvements were obtained with relatively low daily doses: clomipramine at 25 to 50 mg, and fluoxetine at 20 to 40 mg. Adverse effects appeared greater and much less tolerable with clomipramine alone than with the clomipramine-fluoxetine combination. This drug combination was well tolerated. These preliminary data suggest that relatively low doses of a clomipramine-fluoxetine combination may potentiate therapeutic effects and minimize adverse effects in OCD patients. Larger controlled trials are suggested.
据报道，氯米帕明对治疗强迫症（OCD）有效。然而，儿童和青少年对三环类药物的不良反应耐受性较差。氟西汀和其他5-羟色胺再摄取抑制剂对强迫症似乎也有效，且比氯米帕明更安全。为了使治疗效果最大化并将不良反应最小化，对6名患有强迫症的青少年进行了氯米帕明-氟西汀联合用药的单病例试验。联合药物治疗的持续时间从4周至超过28周不等。患者首先单独使用氯米帕明进行治疗；如果改善情况或不良反应不尽人意，则给予联合用药。单独使用氯米帕明时，3例患者临床整体改善程度中等，3例患者改善程度极小。采用氯米帕明-氟西汀联合治疗时，5例患者改善明显，1例患者改善程度中等。这些改善是在相对较低的日剂量下取得的：氯米帕明25至50毫克，氟西汀20至40毫克。单独使用氯米帕明时出现的不良反应似乎更多，且耐受性远不如氯米帕明-氟西汀联合用药。这种联合用药耐受性良好。这些初步数据表明，相对低剂量的氯米帕明-氟西汀联合用药可能增强对强迫症患者的治疗效果并将不良反应最小化。建议进行更大规模的对照试验。
