title: Pulse loading versus gradual dosing of intravenous clomipramine in obsessive-compulsive disorder.
abstract: OBJECTIVE
  We compared gradually increased to pulse loaded doses of open-label, intravenous clomipramine (CMI) in patients with obsessive-compulsive disorder (OCD).
  
  
  METHODS
  We treated adult outpatients with DSM-III-R OCD, who had no prior exposure to effective treatments. Pulse loading patients received 150 mg on day 1; 150 mg or 200 mg on day 2. Gradual dosing patients received 25 mg per day increased to 200 mg per day over 2 weeks and then continued for a mean of 43 days (n=40). After i.v. dosing, all patients received oral CMI; the total treatment period was 6 months.
  
  
  RESULTS
  Pulse loading completers (n=7) had a rapid, dramatic response (mean Y-BOCS score decrease of 32% five days after pulse-loading). At this point (day 7), completers in the gradual intravenous group (n=20) exhibited no mean change in Y-BOCS score. The pulse loading group reached both a 25% or greater and a 50% or greater decrease in Y-BOCS score statistically and clinically significantly faster than the gradual group.
  
  
  CONCLUSIONS
  Pulse-loaded intravenous CMI for the treatment of OCD deserves further study.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University Medical Centre, OCD Clinic, CA 94305, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Koran
authors.forename: S
authors.initials: S
authors.lastname: Pallanti
authors.forename: R S
authors.initials: RS
authors.lastname: Paiva
authors.forename: L
authors.initials: L
authors.lastname: Quercioli
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D002997:Clomipramine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000523:psychology
chemical_list: D000929:Antidepressive Agents, Tricyclic; D002997:Clomipramine