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Double-Blind Data Show No Effect With Escitalopram in Compulsive Shopping Disorder: Presented at APA

By Danny Kucharsky

TORONTO, CANADA -- May 23, 2006 -- Escitalopram may not be generally effective for compulsive shopping disorder or its therapeutic effect may be lost for many patients after a few months of therapy at a constant dose, according to a study presented here at the American Psychiatric Association Annual Meeting (APA).

The double-blind, placebo-controlled, discontinuation trial of escitalopram was conducted to ascertain the safety and efficacy of escitalopram for treating compulsive shopping disorder.

Investigator Elias Aboujaoude, MD, clinical instructor in psychiatry and behavioral science, Stanford University Medical Center, Stanford, California, presented the study's findings on May 22^nd.

Compulsive shopping disorder affects 2% to 8% of the US adult population, Dr. Aboujaoude said. The disorder is characterized by a preoccupation with shopping for unneeded items and the inability to resist purchasing despite adverse consequences, he said. It's commonly associated with mood and impulse control comorbidities and affects women 9 times more frequently than men, he said.

Compulsive shopping disorder is not acknowledged as a specific disease entity in the Diagnostic and Statistical Manual -- Revision IV and, instead, falls into the category of impulse control disorders.

The escitalopram trial was conducted following a 9-week, double-blind discontinuation trial with citalopram in 2003 that demonstrated its safety and efficacy as treatment for compulsive shopping disorder (63% vs 0% relapse for placebo and citalopram, respectively; Fisher exact test, P =.19).

Escitalopram is the active drug component in the racemic mixture that constitutes citalopram, so Dr. Aboujaoude and colleagues decided to conduct a study with escitalopram to parallel the citalopram trial.

Ads were used to recruit 26 women who met inclusion criteria (including symptoms of compulsive shopping disorder for more than 1 year). Subjects had Yale-Brown Obsessive-Compulsive Scale-Shopping Version (YBOCS-SV) scores of >/= 17.

In the initial open-label phase of the study, there was a significant mean decrease in YBOCS-SV scores from 24.5 ± 3.9 at baseline to 9.9 ± 9.3 at week 7 (P <.001).

Seventeen of the 26 patients met responder criteria and were randomized to double-blind treatment (escitalopram, n = 8; placebo, n = 9). Responders in the escitalopram group received dosages of 10 mg/day or 20 mg/day.

The double-blind study found 62.5% of patients in the escitalopram arm and 66.7% in the placebo arm had a compulsive shopping relapse (Fisher exact text, P =.38) and time to relapse was only slightly later in the escitalopram-treated subjects than placebo. Compulsive shopping relapse did not closely correlate with depressive symptom recurrence.

Dr. Aboujaoude said double-blind results were not consistent with results obtained in the study for citalopram in compulsive shopping disorder patients. In the previous study, 5 of 8 citalopram responders who were randomized to placebo relapsed compared with none of 7 patients who were randomized to citalopram continuation.

The investigators said that larger, double-blind, placebo-controlled studies that may discriminate drug response from placebo response are warranted to determine the efficacy of selective serotonin reuptake inhibitors in compulsive shopping disorder.

The study was sponsored by Forest Laboratories.


[Presentation title: Escitalopram for Compulsive Shopping Disorder: A Double-Blind Study. Abstract NR 617]

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