combination of citalopram and nortriptyline in the treatment of obsessive-compulsive disorder: a double – blind, placebo-controlled trial

objective: the fact that some antidepressants with strong effects on serotonin reuptake blockade fail to relieve obsessive-compulsive symptoms has caused growing interest in investigating noradrenergic function in obsessive-compulsive disorder (ocd) . in light of the above, we undertook a trial to investigate whether the combination of citalopram with nortriptyline is more effective in treating obsessive-compulsive symptoms than citalopram alone. method: 40 patients who met the dsm-iv criteria for ocd were included in the study. patients were allocated in a random fashion: 20 patients to citalopram 40mg /day plus nortriptyline 50mg /day, and 20 patients to citalopram 40mg /day plus placebo. results: both protocols significantly decreased the scores of the yale-brown obsessive compulsive scale (y-bocs) over the trial period, but the combination of citalopram and nortriptyline showed a significant superiority over citalopram alone in the treatment of ocd. conclusion: as this study indicates, nortriptyline improves the efficacy of citalopram. in addition, a rapid onset of action is one of the advantages of this combination. this study supports further investigation of the noradrenergic– serotonergic hypothesis in ocd.