In the October-December 2007 edition of the European Journal of Psychiatry, Persson and colleagues report on the use of an infusion of Clomipramine, one of the older antidepressants, in patients with depression. The paper is curiously titled ‘Pulse Intravenous Clomipramine as an alternative antidepressant treatment to ECT. A Pilot Study’. The reference to ECT is made because of the sample selection. People who were due to undergo ECT were chosen to take part in this study. However there was no comparison with ECT which is an extremely useful treatment in selected cases. 23 people were recruited to the study and the authors acknowledge that this is a small number although they were able to achieve statistically significant results.
People in the study had a diagnosis of major depressive disorder and received an infusion of 200mg of Clomipramine in 500ml’s over 30 minutes. Depression was measured using the MADRS depression rating scale and the Clinical Global Impression Scale was also used. Clomipramine was given in tablet form the day after infusion, initially at 75mg and then 150mg. As the data was routinely collected retrospectively as part of a quality assurance program, the authors didn’t need to go through the Ethics Committee according to local policy.
MADRS and CGI scores were compared before the infusion and six days afterwards and compared using a T-test. There was found to be a significant improvement in MADRS scores of 13.1 (C.I 9.5-17 p <0.0001) and a CGI change of 1.6 points (C.I 1-2.1 p < 0.0001). Both of these changes are clinically as well as statistically significant and although one person withdrew due to dizziness there weren’t any significant adverse effects.
The study is a useful one, drawing attention to the IV administration of an antidepressant which can be indicated in specific circumstances (e.g. when a person isn’t tolerating oral intake). However there are a number of cautions. As there was no placebo control group, the ‘placebo response’ may have accounted for a drop in scores. Patients were followed up only for a week and the concurrent administration of oral clomipramine makes it difficult to draw conclusions about the significance of the IV infusion. Also the rapid and large response to treatment in such a short space of time means that larger replication studies would be indicated.
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