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Are Effective Antiobsessional Drugs Interchangeable?

Raed R. Tamimi, MD; Matig R. Mavissakalian, MD
Arch Gen Psychiatry. 1991;48(9):857-858. doi:10.1001/archpsyc.1991.01810330081013.
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To the Editor.—  Pigott et al1 reported on a double-blind, crossover comparison of clomipramine hydrochloride with fluoxetine hydrochloride in the treatment of obsessive-compulsive disorder (OCD), and concluded that these agents were overall similarly effective. Recently, we also presented data showing clomipramine and fluvoxamine maleate, another selective serotonin reuptake inhibitor, to be equally effective in treating patients with OCD.2 In this letter, we address the question about the sequence, and the interchangeability of clomipramine with these other drugs in the treatment of the same patient with OCD. This is of particular interest when the clinician is faced with patients who do not respond, or respond, but cannot tolerate an initial trial using one of these agents.By using a 20% improvement difference between treatments, Pigott et al reported that five patients were preferential responders to clomipramine, two were preferential responders to fluoxetine, and four responded similarly to both agents.

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