Clomipramine and exposure for obsessive-compulsive rituals: I

Abstract

Forty chronic obsessive-compulsive ritualizers were randomly assigned to treatment with oral clomipramine or placebo for 8 mth. During wk 4 to 7, these 2 groups were each randomly split into treatment by relaxation or by exposure in vivo, and during wk 7 to 10, all patients had exposure in vivo. Double blind assessments were made at wk 4, 7, 10, 18, 36, 62 and 114. Results are reported to 1 yr. Clomipramine produced significant improvement in rituals, mood and social adjustment, but only in those patients who initially had depressed mood. The clomipramine effect was maximum from wk 10 to 18 and diminished thereafter. On stopping, clomipramine patients often relapsed and improved again on restarting the drug. Relaxation produced little change. Exposure produced significant lasting improvement in rituals, but less change in mood; improvement generalized to social adjustment at follow-up. Clomipramine plus exposure had a slight additive but not interactional effect. Clomipramine enhanced compliance both with exposure and with relaxation. Clomipramine is useful for compulsive ritualizers with depressed mood, but may need continuation for over a yr and combination with exposure in vivo. Exposure in vivo remains the treatment of choice for rituals without depressed mood.