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| |  Escitalopram Acts as Placebo in Treatment of Compulsive Shopping and Kleptomania: Presented at ECNP By Mark Pownall AMSTERDAM, THE NETHERLANDS -- October 27, 2005 -- The antidepressant escitalopram failed to show any efficacy compared with placebo in subjects with compulsive shopping disorder or kleptomania in 2 pilot trials. Results were presented here at the 18th Congress of the European College of Neuropsychopharmacology (ECNP) on October 24th. In the first trial, Lorrin M. Morran, MD, professor of psychiatry and director, Obsessive-Compulsive Disorder Clinic, Stanford University Medical Center, Palo Alto, California, and colleagues assessed the response to escitalopram among 26 women with a mean age of 29 years who had been diagnosed with compulsive shopping disorder. Dr. Koran said those women who responded over an initial 7-week phase were randomized to further treatment with escitalopram or placebo. In total 17 subjects entered the 9-week double-blind phase of the trial. The researchers defined response as improvement on a clinical global impression scale score of 1 or 2 (very much or much improved) and a 50% or greater improvement on the Yale Brown Obsessive-Compulsive Scale -- Shopping Version (YBOCS-SV). Results show no statistical difference in relapse rates at 9 weeks between the treatment groups: 5 of the 8 patients (62.5%) on escitalopram and 6 of 9 (66.7%) on placebo. Time to relapse was slightly later in the escitalopram group, although the numbers were very small, Dr. Koran said. Relapse did not seem to coincide with the return of symptoms of depression, he noted. The researchers concluded that the response during the open-label phase of the trial was "largely or wholly' a placebo response. The results contradict those of an earlier, identically designed study on citalopram, a racemic mixture that contains escitalopram, and suggest a larger double-blind study is needed to identify subgroups of patients who may respond to escitalopram, according to the researchers. A similar study on kleptomania by the same research group had a similar negative outcome. The kleptomania trial enrolled 17 women and 7 men with a mean age of 49 years, who had kleptomania for at least 1 year. Subjects were randomized to escitalopram or placebo and were treated for 4 to 7 weeks depending on response. The researchers defined treatment response as a 50% or greater decrease in the number of thefts per week, and a "much improved" or "very much improved" clinical global impression score. As in the compulsive shopping trial, the relapse rates in the 2 treatment arms were statistically the same. The researchers say a placebo response is the most likely explanation for the improvement in kleptomania observed in the open-label phase. However, they conclude, "Kleptomania may be a behavioral pathology with various underlying causes. A true drug effect of escitalopram, removing or markedly reducing the urge to steal in some individuals, cannot be ruled out by results of this small study." The studies were supported by Forrest Laboratories Inc. Citations:
[Presentation title: Escitalopram Treatment of Kleptomania: an Open Trial With Double-blind Discontinuation. Abstract P.8.033; Escitalopram Treatment of Compulsive Buying Disorder: an Open Trial Followed by Double-Blind Discontinuation. Abstract P.8.044]
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