Clomipramine for OCD: Exploring its Therapeutic Benefits

For decades, obsessive-compulsive disorder (OCD) has been treated with medication, psychotherapy, self-help tools, and natural remedies like vitamins, St. John’s Wort, crystals, probiotics, essential oils, and CBD. Although, the first-line treatment for OCD is psychotherapy, specifically, cognitive-behavioral therapy (CBT) and exposure-response and prevention (ERP) therapy, sometimes, this approach is ineffective when used alone. When this occurs, a new approach is often warranted.

This new approach tends to involve medications, most commonly, SSRI antidepressants. While many OCD sufferers received relief from their non-stop obsessions and repetitive and ritualistic compulsion after using SSRIs, like Paxil, Prozac, and Zoloft, others have found this category of antidepressants harmful or ineffective. The good news is that there are several types of prescription medications, including other types of antidepressants, that can be used to ease OCD symptoms.

One alternative antidepressant that is often used to treat OCD is clomipramine. Clomipramine is a tricyclic antidepressant designed to reduce or alleviate the intrusive thoughts, urges, fears, emotions, and visions (obsessions), and the rituals or routines (compulsions) that accompany the obsessions.

Treating OCD often involves trial and error until the right combination of treatments is found. This may include trying different types of therapy, such as acceptance and commitment therapy (ACT), trauma therapies, or art therapy, and/or trying different medications, such as SSRI antidepressants, SNRI antidepressants, or tricyclic antidepressants like clomipramine.

Remember, no two OCD sufferers are exactly the same which means no two treatment approaches are exactly the same. If first-line OCD medications (SSRIs) have not worked, or have produced unwanted side effects, clomipramine may be a viable alternative. In fact, researchers found that clomipramine is more effective at reducing OCD symptoms than other medications (i.e., amitriptyline, imipramine, desipramine, nortriptyline, or clorgiline) used to treat OCD.

Thus, if you have been struggling to find the right OCD treatment, and have found that first-line OCD medications like SSRIs have been ineffective or damaging, then you have come to the right place. In this article, we will explore the therapeutic benefits of clomipramine, so you can determine if it is the right treatment for you.

What is Clomipramine?

Clomipramine, the generic form of Anafranil, is a tricyclic antidepressant that is FDA-approved to treat OCD symptoms – i.e., unwanted and involuntary intrusive thoughts, urges, visions, emotions, and thoughts (obsessions), and repetitive ritualistic behaviors (compulsions). Clomipramine is the only medication approved to treat OCD.

How Does Clomipramine Help OCD?

Clomipramine helps OCD by boosting serotonin in the brain. Serotonin is the hormone/neurotransmitter responsible for regulating a person’s mood, and behavior. Researchers have found that people with OCD tend to have low serotonin in their brains, leading to cyclic OCD symptoms – non-stop, involuntary, repetitive, and intrusive thoughts, emotions, urges, fears, and compulsive behaviors. Tricyclics like clomipramine are designed to restore serotonin in the brain, which in turn, can “quiet” the mind and stop compulsive behaviors.

What Clomipramine Dosages Are Available for OCD?

Clomipramine is available in capsule form in the following dosages: 25 mg, 50 mg, and 75 mg.

For Adults With OCD

• Starting dose: 25 mg by mouth 1x a day before bed
• Maintenance dose: 100 mg by mouth 1x a day 
• Maximum dose: 250 mg by mouth 1x a day

Notes

• The initial dosage (25 mg) should be increased gradually to 100 mg over 14 days. After the 14th day, the dose (100 mg) may be slowly increased over the next few weeks until you reach the maximum dosage of 250 mg, per day.
• In the beginning, the dosage should be divided into 2 or more doses (taken with meals) to reduce or eliminate gastrointestinal side effects (i.e., nausea, diarrhea, constipation, vomiting, upset stomach, abdominal pain).
• During the maintenance period, the dosage (100 mg) should be taken before bed to reduce daytime sedation.
• Every effort should be made to keep you on the lowest effective dosage of clomipramine.

For Pediatric (Children & Teens) With OCD

Ages: 10 to 17 

• Starting dose: 25 mg by mouth 1x a day before bed
• Maintenance dose: Can increase (if necessary) from 3 mg to 100 mg 1x a day is reached
• Maximum dose: from 3 mg by mouth 1x a day to 200 mg 1x a day 

Notes

• During the initial days, this drug should be divided into 2 or more doses (taken with meals) to reduce gastrointestinal side effects like nausea, vomiting, upset stomach, abdominal pain, diarrhea, or constipation.
• Once the maintenance dosage is reached, the total daily dose should be used before bed to reduce or eliminate daytime sedation.
• Every effort should be made to keep the child on the lowest effective dosage.

Can Children With OCD Use Clomipramine?

Yes, OCD sufferers over the age of 9 can use clomipramine for their symptoms.

Is There Anything I Should Know Before Using Clomipramine for OCD?

Yes, there are some things you should be aware of before using this medication for OCD, such as:

• Do not use clomipramine if you recently had a heart attack.
• Do not use this medicine if you have used an MAO inhibitor like isocarboxazid, linezolid, methylene blue injection, phenelzine, rasagiline, selegiline, or tranylcypromine in the past 2 weeks (14 days). 
• You may initially experience suicidal thoughts after taking this medication, especially if you are a child or young adult. So, alert your doctor and OCD therapist if you start to experience sudden mood swings, depression, severe anxiety, or suicidal thoughts while on it. 
• Do not use this medication if you are allergic to the following antidepressants: amitriptyline, amoxapine, trimipramine, desipramine, doxepin, imipramine, nortriptyline, or protriptyline.
• Alert your doctor and OCD therapist if you have used an SSRI antidepressant (i.e., citalopram, escitalopram, fluoxetine (Prozac), fluvoxamine, paroxetine, sertraline (Zoloft), trazodone, or vilazodone) in the past 5 weeks before using this medication for OCD.
• Also alert your doctor and OCD therapist if you have one of the following conditions or health issues: liver or kidney disease, bipolar disorder, schizophrenia, or another mental health condition, alcohol addiction, seizures, a concussion, traumatic brain injury (TBI), cardiovascular “heart” disease, hypotension or low blood pressure, narrow-angle glaucoma, a hyperactive thyroid, an adrenal gland tumor like pheochromocytoma or neuroblastoma, and/or urination problems before using clomipramine for OCD.
• Inform your doctor and OCD therapist of any stimulants, opioids, herbal products, and/or other medications for anxiety, depression, or another mental health condition, Parkinson’s disease, migraines, severe infections, and/or nausea medications. This is important because the products can interfere with clomipramine, triggering serotonin syndrome or too much serotonin in the brain.
• It can take up to a month (4 weeks) for your OCD symptoms to improve. Do not stop this medication prematurely, but alert your doctor if your symptoms do not improve after a month.
• Alert your doctor and OCD therapist if your OCD symptoms do not improve, or if they worsen.
• If you are scheduled for surgery, alert your surgeon that you are using clomipramine for OCD. You may need to stop taking this medication 2 or more weeks before the surgery and some time afterward.
• Avoid drinking alcohol while using clomipramine for OCD because it could lead to dangerous situations. Your reaction times could be delayed.
• If you suddenly stop using clomipramine suddenly, you may experience unpleasant medication withdrawal symptoms. Ask your doctor how you can safely stop using clomipramine.
• Because of the side effects, you may only be able to use this medication for your OCD for 10 weeks.

Could I Experience Side Effects While Using Clomipramine for OCD?

Yes, like any other medication, you may experience side effects while using clomipramine for OCD. These side effects will likely diminish or go away as your body adapts to the medication.

Some of the side effects that you could initially experience after starting this medication for OCD include:

• Low Sodium Levels 
• Headaches
• Confusion
• Slurred Speech
• Extreme Weakness
• Vomiting
• Poor Coordination
• Unsteadiness
• Blurry Vision
• Tunnel Vision
• Reduced Vision
• Eye Pain 
• Eye Swelling
• Seeing Halos Around Lights
• Extreme Fear
• Suicidal Ideation or Thoughts of Harming Yourself
• Painful or Burning Urination
• Seizure or Convulsions
• Dizziness or Drowsiness 
• Fatigue 
• Nervousness
• Tremors or Jerky Muscle Movements
• Profuse Sweating
• Appetite or Weight Changes
• Reduced Libido or Sex Drive
• Impotence or Erectile Dysfunction (Difficulty Having an Orgasm)

Notes: Inform your doctor and OCD therapist of any new or worsening symptoms, such as mood swings, anxiety, panic attacks, insomnia, an urge to be impulsive, irritability, agitation, hostility, aggression, restlessness, hyperactivity, increased depression, suicidal ideation (thoughts or attempts), or thoughts of self-harm. suicide or hurting yourself.

Can I Use Clomipramine For OCD While Pregnant or Breastfeeding?

Yes, you can, but clomipramine use for OCD during pregnancy must be closely monitored. Keep in mind that using this medication during the third trimester can lead to clomipramine withdrawal symptoms in newborn babies. However, clomipramine should not be used while breastfeeding.

What Does The Research Say?

According to a meta-analysis review, clomipramine appears to be more effective than other OCD medications like sertraline, fluoxetine, and fluvoxamine. Researchers also found that men (not women) experienced an improvement in their OCD compulsions after using clomipramine for 6 months. However, some researchers found that while clomipramine appears to be effective and well-tolerated for many OCD sufferers (with the most common side effect being nausea), other antidepressants may be just as effective as clomipramine for treating OCD.

Moreover, a 2019 study indicated that an SSRI/clomipramine combo along with CBT/ERP therapy is more effective for treatment-resistant OCD than SSRI, clomipramine, CBT, or ERP therapy alone. An early study also found that clomipramine is well-tolerated and effective for reducing OCD symptoms – obsessions and compulsions. Likewise, a 2016 study found that intravenous clomipramine may be beneficial for severe OCD symptoms that have not adequately responded to other interventions, including the pill form of clomipramine. 

Previous research also suggests that clomipramine is an effective way to manage OCD, however, researchers discovered a variety of possible side effects (i.e., dry mouth, visual disturbances, constipation, sexual dysfunction, somnolence, tremors, dizziness, and overdose). On the flip side, however, other researchers found that clomipramine does not reduce or alleviate OCD symptoms in people who are treatment-resistant to SSRIs.

Clomipramine For OCD Reviews

The best way to determine how beneficial clomipramine could be for you is to read the reviews of others who have used it for their OCD symptoms.

Listed below are various reviews of people who are or have used clomipramine for their OCD:

• “Being serious now I take it you’ve tried a number of meds and are now onto the tricyclics, one stop before the MAOIs.All of the doctors I have seen have called tricyclics ‘gold-class’ antidepressants as they work really well. However, tricyclics appear to have ‘gone out of fashion’ because of SSRIs that have fewer side effects.
• I came out of the hospital and was prescribed imipramine, which was ok but it never really helped beyond that. Finally, my doctor put me on 150-200 mg of Clomipramine, which I stayed on for about three years. Clomipramine helped me with depression and obsessional/rumination anxiety. It never really helped all that much with my depression, but at least I was functional.
• I have treatment-resistant depression, so maybe it helps people with MDD better. However, clomipramine really helped with my anxiety, which is why it is one of the few medications approved for OCD. Just be prepared for side effects like sweating, constipation, dry mouth, and sexual dysfunction. Still, it is definitely worth a try, if your usual medications have not worked.”
• “The best medication so far for OCD is Anafranil. It completely cured my OCD. Remember OCD is just a medical problem due to unbalanced chemicals in your brain. It’s not you, it’s your brain sending you false messages. Don’t believe the obsessive thoughts, they may feel real but they are fake!”
• “I had anxiety and intrusive obsessive thoughts so bad that I had insomnia for 3 years. I was an absolute mess, lost 50 lbs, and could barely function. I ended up being hospitalized for a week and was put on Anafranil 50 mg at night. It took about two weeks but I started to see a light at the end of a very dark tunnel! I had tried almost everything on the market and Anafranil finally helped! Today is 7 years now that I have been on this medication. I feel great and it saved my life!!”
• “Anafranil gave me a very serious balance problem. Within days of it for OCD, I began stumbling up the subway steps. The psychiatrist assured me it could not be from Anafranil. Over a period of a few years I twice fell and had to be treated and receive facial stitches in the emergency room, lost part of a front tooth, and suddenly fell for no apparent reason walking down the street, climbing stairs, going downstairs.
• I could have had extreme injuries, or in the case of falling down 15 steps at the train station died. I asked my psychiatrist about Anafranil causing the falls. He said it would not in any way have caused these falls. On reporting my fall to an audiologist she told me that research shows that Anafranil indeed does lead to balance problems in 30% of people taking it.”
• “Anafranil helped my OCD symptoms a little bit and helped me sleep at night. However, as my doctor increased my dosage, I started gaining weight, having horrible acne, and SEVERE constipation. It also made me crave junk food like some kind of addict. I was on Anafranil for about 10 months and gained 40 lbs. I haven’t taken Anafranil in about 8 months.
• I have lost 40 lbs. I didn’t have to go on a diet or anything, as soon as I was off the drug my appetite went back to normal. However, 8 months later and my colon is still not healthy. I still have major issues with constipation and bloating. My doctor had me try Zyliss, a drug for IBS, and it helps a little. I feel like Anafranil may have ruined my gut. I have a hard time leaving the house because I am so uncomfortable in my gut. I wish I had never taken this drug. I was much better off before.”
• “I took Anafranil for 5 months at a dose of 25mgs. It definitely took some, but not all of the power away from my intrusive thoughts. While on the medication, I was extremely tired in the mornings. I had terrible dreams and was having mild constipation. On a positive note, I did not gain any weight and was able to work out regularly. I tried to go up to 50 mg, but when I did it reduced my libido. I felt like taking an ‘upper’ and ‘downer’ at the same time. Sometimes, I felt good, while other times, I felt depressed. Unfortunately, I couldn’t tolerate the higher dose. But, if you really need to ‘shut off the noise,” this may be the way to go. Best of luck.”
• “If you’re compulsively looking for evidence for why or why you shouldn’t take this medication, stop right now and leave this website! Seriously. Been there many times. Anafranil is a promising drug for the majority of people with OCD and it’s worth a shot. I gave it a solid 10 weeks and decided it wasn’t the med for me (too many side effects such as fatigue etc and did not feel like myself on it).
• Feeling a little better w/o it so far (knock on wood), but that doesn’t mean it won’t work for you. The only way to know is to try it, and it won’t hurt you. Listen to your doctors, but always listen to your body first. If something feels off, don’t ignore it. Your doctors want the best for you, but only you can truly know what’s working and what isn’t. Now, that said, take a leap of faith and stop researching. My personal experience with this drug should mean nothing to you.”

Final Thoughts

Although SSRIs are the first-line medication used to treat OCD, clomipramine (Anafril) is the only medication approved by the FDA to treat OCD. And, while many people receive relief from SSRIs, this class of medicine does not work for all OCD sufferers. When SSRIs are ineffective or harmful to the user, the next step is to try another medication, usually another antidepressant. This is where tricyclic antidepressants, like clomipramine, come into play. This tricyclic antidepressant has been proven to help OCD sufferers who have not gotten relief from other antidepressants.

For some, it is the only medication that reduces their OCD symptoms. However, clomipramine also comes with possible side effects with some of them being severe. Therefore, it is important that you discuss the pros and cons of using this medication for your OCD with your doctor, OCD therapist, and loved ones before committing to it. Still, for those who simply want to have a normal, productive life, clomipramine may be a good alternative option. Another benefit? It can be combined with other OCD treatments, such as hypnosis, psychotherapies, acupuncture, art therapy, mindfulness, and/or online OCD treatment programs like Impulse Therapy.

With the right medication, you can have the OCD-free life you want and deserve!

References

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