Jury out on antidepressants for kleptomania

The antidepressant Lexapro does not appear to be an effective treatment for people suffering from kleptomania, according to the first controlled study to look at drug treatment for the disorder. But a few patients in the small study did get better while on Lexapro, also known as escitalopram.

"The study does not provide evidence that escitalopram works for kleptomania but does not close out the possibility that some patients with the disorder may have a response to the drug," Dr. Lorrin M. Koran of Stanford University School of Medicine, the study's lead author, told Reuters Health.

There is currently no proven effective treatment for kleptomania, in which a person cannot resist impulses to steal things, often objects of little worth. Some case reports and uncontrolled studies, meaning they did not include a placebo group, have shown promise for the "selective serotonin inhibitor" (SSRI) class of antidepressant drugs.

Koran and his team treated 24 kleptomaniacs with the SSRI Lexapro for seven weeks. Those who showed a response to the drug were then randomized to continue on Lexapro or switch to placebo for another 17 weeks.

Forest Pharmaceuticals, which makes Lexapro, funded the study.

Nineteen subjects (79 percent) showed a response during the first treatment phase, defined as a reduction in theft episodes of more than 50 percent and "much improved" or "very much improved" symptoms overall.

Several patients dropped out of the study, so only 15 were randomized. Three of the seven patients on Lexapro (43 percent) relapsed during the second phase of the study, compared to 4 of the 8 patients on placebo.

The findings strongly suggest that the early response seen in the study was due to a placebo effect, Koran and colleagues say. However, Koran noted in an interview with Reuters Health, some patients said the drug "changed me," and said they were now able to go into stores without feeling the urge to steal. Given that they had sought help for kleptomania many times in the past without success, "it's hard to believe that's placebo," Koran said.

People who do suffer from kleptomania should seek help, Koran urged. "Definitely treatment is worth pursuing," he said. "Without treatment they're not likely to get better -with treatment there's a chance."

In addition to antidepressants, naltrexone, a drug used to treat addiction and some impulse control disorders, has also shown promise for kleptomania. Cognitive behavioral therapy may also help some individuals with the disorder.

SOURCE: Journal of Clinical Psychiatry, March 2007.