Clomipramine versus sertraline in the treatment of obsessive compulsive disorder

Objective: The aim of this study was to compare the efficacy, safety, and tolerability of sertraline and clomipramine in the treatment of obsessive-compulsive disorder (OCD). Method: Outpatients met the DSM-IV criteria for OCD for 1 year or longer and scores of . 20 on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and . 4 on the Clinical Global Impression Severity Scale (CGI-S) were included in the study. Patients who had significant concomitant physical disease, suicidal tendency, a history of seizure or organic brain disorder, substance abuse within the previous sixth months, DSM-IV axis I diagnoses other than OCD and who had had medication for 1 month were not included in the study.Patients were randomized to receive 8- week of single-blind treatment with either fixed dose of sertraline (n=20) 50 mg/day or clomipramine (n=22) initially 50 mgĞday and 150 mg/day after 1 week. No additional medication was given to patients. Clinical evaluations were conducted before the treatment and on two-week schedule throughout the 8-week trial using the Y-BOCS and theCGI-S. Results: Four of clomipramine (18.2%) and 2 of sertraline (10.0%) patients dropped out because of adverse events or lack of effectiveness. Thirty six patients completed the trial (sertraline n=18; clomipramine n=18). The mean baseline Y-BOCS and CGI-S scores were 24.95 and 4.75 respectively for sertraline and 23.54 and 4.85 for clomipramine (p>0.05). A significant reduction in OCD symptoms from baseline to the end of 8 th week of the trial was found in both sertraline and clomipramine treated groups (p0.05). The number of patients withdrawn because of adverse events was substantially greater for clomipramine (22.2%) than sertraline (11.1%). The incidence of side effects was significantly higher in clomipraminetreated patients versus sertraline-treated patients. The most frequent adverse events with sertraline were headache (38.8%), nausea (33.3%), irritability (11.1%) and tremor (11.1%), while clomipramine was most commonly associated with dry mouth (50%), weight gain (50%), constipation (27.7%), yawning (27.7%), sedation (22.2%) and dizziness (11.1%). Conclusions: At fixed doses, both clomipramine and sertraline showed a similar therapeutic efficacy in the treatment of OCD. Clomipramine produced more side effects and dropout rate. The results indicate that sertraline is as effective as clomipramine in the treatment of OCD and is better tolerated.