Neuroendocrine predictors of response to intravenous clomipramine therapy for refractory obsessive-compulsive disorder

Sanjay J. Mathew, Jeremy D. Coplan, Kathryn A. Perko, Raymond R. Goetz, Manuel De La Neuz, Eric Hollander, Michael R. Liebowitz, Brian A. Fallon

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

The current study examines the neuroendocrine response to intravenous clomipramine (IV CMI) in oral CMI-resistant obsessive-compulsive disorder (OCD) patients on day 1 and day 14 of treatment to identify predictors of response. Forty-four OCD patients with an inadequate response or poorly tolerant to oral CMI were begun at 25 mg IV CMI, increasing to 250 mg by day 10, and continuing on that dose to day 14. On day 1, plasma levels of prolactin (PRL), growth hormone (GH), and cortisol were obtained immediately before the 25 mg IV infusion, and at five 30-minute time points after the infusion. On day 14, hormonal samples were obtained in a similar fashion. Response was assessed by the Clinical Global Impressions (CGI). Low PRLMAX to IV CMI and low cortisol levels overall on day 1 were both significantly associated with clinical response at day 14. An overall increase in growth hormone (GH) secretion during the day 14 testing was associated with positive response. A pronounced PRL response to IV CMI on day 14 was exhibited by the nonresponders, whereas a smaller and later but significant increase in PRL was noted in the responders. The findings suggest that in this sample of oral CMI-resistant patients with OCD, neuroendocrine measures derived from pharmacological challenge with IV CMI are capable of distinguishing IV CMI treatment responders from nonresponders. The limitations of IV CMI as a specific probe of serotonin function are discussed.

Original languageEnglish (US)
Pages (from-to)199-208
Number of pages10
JournalDepression and Anxiety
Volume14
Issue number4
DOIs
StatePublished - 2001
Externally publishedYes

Keywords

  • Cortisol
  • Growth hormone
  • Intravenous clomipramine
  • Obsessive compulsive disorder
  • Pharmacological challenge
  • Prolactin

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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