Stanford Report Online

Stanford Report, December 13, 2000
Drug offers promising lead in treating compulsive urge to shop


'Tis the season to go shopping. But occasionally the urge to scour the malls isn't driven by a last-minute, gift-giving panic. Some people have an irresistible urge to buy even useless or unwanted items, no matter what the season. They may find it impossible to stop thinking about shopping and sometimes spend hours each day planning their next purchase.

These uncontrollable thoughts and actions are hallmarks of compulsive shopping disorder -- a serious, difficult-to-treat condition that may affect up to 8 percent of the population. Stanford researchers are looking for volunteers to participate in an ongoing study to test the ability of a drug to curb this irresistible urge. Preliminary results of the first trial of the drug in 24 patients have been very promising, said study leader Lorrin Koran, MD.

"Patients in the preliminary study reported feeling less anxiety, less depression and less impulsiveness. Most participants said they stopped thinking about shopping and lost interest in it," said Koran, professor of psychiatry and behavioral sciences.

Research coordinator Michael Elliott said compulsive shopping is often associated with depression, and more than 90 percent of sufferers are women.

Although the stereotype of a woman overusing her credit card at the mall is often played for laughs, sufferers and their family members know it's anything but funny. The disorder, categorized as an impulse control disorder by the American Psychiatric Association, can lead to family strife and financial ruin.

"Compulsive shopping often has serious, unpleasant consequences and should be a matter of public concern," said Koran, who is also the director of the Obsessive-Compulsive Disorder Clinic at Stanford. Some of his patients with compulsive shopping disorder have generated large credit-card debts, taken out second mortgages on their homes, declared bankruptcy and even been divorced as a result of the disorder.

"This chronic impulse is often brought on by or associated with feelings of tension, anxiety, boredom or depression. Purchases are followed by regret, guilt and resolve not to do it again," said Koran.

The study will test a drug called citalopram HBr -- a selective serotonin re-uptake inhibitor related to Prozac. Citalopram, marketed under the trade name Celexa, is currently approved for use as an antidepressant. Koran believes citalopram may also be able to abolish the purchasing impulse in compulsive shoppers.

Potential volunteers for the study will initially be screened over the phone. Those who qualify will receive seven weeks of treatment with citalopram.

Volunteers who experience a marked reduction or cessation in their shopping impulses will then be randomized into one of two groups: one group will continue drug treatment while the other will receive a placebo in place of the drug.

This second part of the study, which will last eight weeks, will be double-blinded to prevent either the doctor or the volunteer from knowing whose medication has been replaced with a placebo. Double blinding the study reduces the chance that the promising results seen in the first round were due to the patients' own expectation of improvement -- a phenomenon known as the placebo effect.

Volunteers will be interviewed weekly at first and then every other week to rate the amount of time spent shopping or thinking about shopping, the associated distress, interference with their functioning and their ability to resist or dismiss the thoughts and impulses.

If you or someone you know is interested in participating in the study, please call the Obsessive-Compulsive and Related Disorders Research Program at (650) 725-5180. Calls will be returned by a researcher who will conduct the initial phone screening.

Results of the preliminary study were presented Dec. 11 by Kim Bullock, MD, at the American College of Neuropyschoparmacology in Puerto Rico. Bullock is a resident of psychiatry at Stanford. Citalopram HBr is trademarked as Celexa and marketed by Forest Laboratories. The preliminary study was sponsored by Forest Laboratories.