By MICHELLE L. BRANDT
While a trip to the mall may mean a cute sweater or new CD for most of us, it has ominous implications for the thousands of Americans who suffer from compulsive shopping disorder, a condition marked by binge shopping and subsequent financial hardship. Now medical center researchers have found that a drug commonly prescribed as an anti-depressant may be able to curb the uncontrollable shopping urges.
In a study appearing in the July issue of the Journal of Clinical Psychiatry, patients taking citalopram, a selective serotonin reuptake inhibitor that is approved for use as an antidepressant, scored lower on a scale that measures compulsive shopping tendencies than those on a placebo. The majority of patients using the medication rated themselves "very much improved" or "much improved" and reported a loss of interest in shopping.
"I’m very excited about the dramatic response from people who had been suffering for decades," said Lorrin Koran, MD, professor of psychiatry and behavioral sciences and lead author of the study. "My hope is that people with this disorder will become aware that it’s treatable and they don’t have to suffer."
Compulsive shopping disorder, which is estimated to affect between 2 and 8 percent of the U.S. population, is categorized by preoccupation with shopping for unneeded items and the inability to resist purchasing such items. Although some people may scoff at the notion of shopping being considered an illness, Koran said this is a very real disorder. It is common for sufferers to wind up with closets or rooms filled with unwanted purchases (one study participant had purchased more than 2,000 wrenches; another owned 55 cameras), damage relationships by lying to loved ones about their purchases and rack up thousands of dollars in debt.
"Compulsive shopping leads to serious psychological, financial and family problems including depression, overwhelming debt and the breakup of relationships," Koran said. "People don’t realize the extent of damage it does to the sufferer."
Earlier studies suggested that the class of medications known as SSRIs might be effective for treating the disorder, but this had not been confirmed through a trial in which participants didn’t know whether they were taking a placebo or the actual medication. Koran and his team sought to test citalopram — the newest SSRI on the market at that time — by conducting a seven-week, open-label trial followed by a nine-week, double-blind, placebo-controlled trial.
The study involved 24 participants (23 women and one man) who were defined as suffering from compulsive shopping disorder based on their scores on the Yale-Brown Obsessive-Compulsive Scale-Shopping Version, or YBOCS-SV. Patients with scores above 17 are generally considered to be suffering from compulsive shopping disorder. Most of the participants had engaged in compulsive shopping for at least a decade and all had experienced substantial financial or social adverse consequences of the disorder.
During the open-label portion of the study, each participant took citalopram for seven weeks. By the end of the trial, the mean score of the YBOCS-SV decreased from 24.3 at baseline to 8.2. Fifteen patients (63 percent) were defined as responders — meaning they self-reported as being "very much improved" or "much improved" and had a 50 percent or greater decrease in their YBOCS-SV scores. Three subjects discontinued their use of the medication because of adverse events such as headache, rash or insomnia.
The responders were randomized into the double-blind portion of the trial in which half took citalopram for nine weeks and the other half took a placebo. Five of the eight patients (63 percent) who took the placebo relapsed — indicated by self-reporting and YBOCS-SV scores above 17. The seven patients who continued the medication saw a decrease in their YBOCS-SV scores and also reported a continued loss of interest in shopping, cessation of browsing for items on the Internet or TV shopping channels, and the ability to shop normally without making impulsive purchases.
"Patients said to me, ‘I go to the shopping mall with my friends and I don’t buy anything. I can’t believe it and they can’t believe it,’ " reported Koran. "They’ve been doing this for decades and now their urge to shop is gone."
Aside from the significant improvement in many patients, Koran said he was most amazed by the amount of time it took for patients to notice a difference in their behavior. "Patients improved within one or two weeks," he said. "I’ve never seen anything like it. No disorder I’ve treated has reacted like this."
Koran said future studies are needed on the effectiveness of this drug and other SSRIs in treating the disorder. He is currently enrolling patients for a similar study using escitalopram, a new type of antidepressant that appears to have fewer side effects than others. Those interested in volunteering for the study can call Stanford’s Obsessive-Compulsive and Related Disorders Research Program at 725-5180.
Koran’s co-authors include Helen Chuong, research coordinator; Kim Bullock, MD, staff physician; and S. Christine Smith, MD, staff physician.
Stanford Report, July 23, 2003