Escitalopram in the Treatment of Impulsive-Compulsive Internet Usage Disorder: An Open-Label Trial Followed by a Double-Blind Discontinuation Phase
J Clin Psychiatry 2008;69(3):452-456
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Background: Isolated reports suggest that escitalopram may be
effective for impulsive-compulsive Internet usage disorder (ICIUD), an
impulse-control disorder characterized by excessive time spent on the Internet
at the expense of occupational, relationship, and social activities. To assess
the safety and efficacy of escitalopram in IC-IUD, we conducted a 10-week, open-label trial followed by a 9-week, double-blind, placebo-controlled
Method: From December 2002 to October 2004, 19 adult subjects
with IC-IUD (defined as time consuming, uncontrollable, distressing, and
resulting in social, occupational, or financial difficulties) were enrolled.
Escitalopram was started at 10 mg/day, then increased and maintained at 20
mg/day for 10 weeks at the end of which completers were randomly assigned to
placebo or escitalopram for 9 additional weeks. Two key outcome measures were
used: hours spent weekly in nonessential Internet use and overall clinical
response (subjects rated "much improved" or "very much improved" on the
Clinical Global Impressions-Improvement scale [CGI-I]).
Results: Fourteen subjects completed the entire study. At the
end of the 10th week of open-label escitalopram, Internet usage decreased
significantly from a mean of 36.8 hours/week at baseline to 16.5 hours/week
(paired t test: t = 3.58; p = .002). In addition, 64.7% of the sample (N = 11)
were considered CGI-I responders. At the end of the double-blind phase, there
were no significant differences in outcome measures between patients taking
placebo compared to escitalopram (analysis of variance with repeated measures,
p > .05).
Conclusion: Patients showed a significant improvement of
IC-IUD symptoms during the open-label escitalopram phase. There was no
significant difference between the escitalopram and placebo groups at the end
of the subsequent double-blind phase; both groups maintained the gains made in
the initial open-label treatment. Larger controlled trials are needed to
investigate the efficacy of this and other pharmacologic agents in the
treatment of IC-IUD.