If I Take Clozapine Will It Improve or Worsen My OCD Symptoms?

Constant intrusive thoughts and non-stop annoying behaviors can create a desperate situation. Most of the time OCD is treated with psychotherapy (i.e., cognitive-behavioral therapy (CBT), acceptance and commitment therapy (ACT), and/or exposure and response prevention (ERP) therapy) and/or antidepressants (i.e., SSRIs). However, sometimes this treatment protocol is not enough to stop the obsessions and compulsions.

When conventional OCD treatments have been unsuccessful – or only partially successful, it is normal to seek other treatments to add to your current prescribed treatment plan. Some OCD sufferers may turn to alternative medications, like CBD, and/or vitamin, mineral, and herbal supplements, while others may turn to lifestyle changes like a healthier diet, more sleep, and/or a new exercise routine. Still, some people with OCD opt to sign-up for an online OCD recovery program, like Impulse Therapy.

And, although not as common as SSRIs, some people with OCD are prescribed antipsychotics, like clozapine. For some, clozapine works, but for others, it causes more problems for OCD sufferers, and in some cases, it triggers or worsens OCD symptoms – making it an unsuitable remedy for OCD. Therefore, before taking this medication, it is important to discuss the pros and cons of taking it for your OCD symptoms.

If you are wondering if clozapine will help or hurt your OCD symptoms, look no more because this article will give you the ins and outs of taking this medication for your condition. With the right treatment, you will be on your way to a brand-new OCD-free life.

What is Clozapine?

Clozapine, the generic version of Clozaril, FazaClo, Versacloz, Clopine, CloZAPine Synthon, Denzapine, and Zaponex (brand names), is an atypical antipsychotic drug, primarily used for treatment-resistant schizophrenia. However, it is also often used “off-label” to treat other mental health conditions, like obsessive-compulsive disorder, social anxiety, post-traumatic stress disorder (PTSD), general anxiety disorder, bipolar disorder, etc. Clozapine is also used to lower the risk of suicidal ideation (suicidal thoughts and/or attempts) in people with mental health issues.

How Does Clozapine Work?

Clozapine targets and attaches to neurotransmitter receptors (serotonin and dopamine) in the brain. Once this atypical antipsychotic attaches to the receptors, it prevents other cells from doing the same. This signal disruption (between neurons or nerve cells) alters your brain chemistry and activity, leading to reduced stress, anxiety, and OCD symptoms.

Is Clozapine Available Over-The-Counter?

No, clozapine is only available by prescription from a specialty pharmacy.

How Much Clozapine Should I Take for OCD?

Although the typical dose for schizophrenia is 12.5-450mg, per day, people with OCD can take up to 100mg of clozapine daily. If this dosage is ineffective, the dosage can be increased to 250mg daily. It can also be combined with aripiprazole if clozapine is unsuccessful. In this case, 10-30mg of aripiprazole can be added to clozapine. The maximum dosage of clozapine is 900mg.

Does Clozapine Come with Side Effects?

Yes, just like any other medication, clozapine does come with side effects, such as:

• Dry “Cotton” Mouth
• Drowsiness
• Irritability
• Sudden Weight Gain
• Diabetes
• Fevers
• Muscle Weakness and Pain
• Headaches/Migraines
• Mental Confusion
• Loss of Appetite
• Nausea
• Vomiting
• Diarrhea
• Excessive Perspiration or Sweating
• Constipation
• Urinary Problems
• Sexual Dysfunctions
• Insomnia
• Dizziness
• Tremors
• Accelerated Heart Rate
• Increased Salivation
• Vision Problems
• Increased Risk of Serious or Deadly Infections (i.e., fever, flu-like symptoms, severe weakness, mouth and/or skin sores, new or worsening cough, trouble breathing, urination pain or burning, and/or vaginal itching or discharge)

Serious and Life-Altering Side Effects

Listed below are possible serious and life-altering side effects:

• Involuntary facial muscle movements (i.e., chewing motions, lip smacking, frowning, tongue flickering, and/or blinking eyes)
• Seizures (i.e., blackout-outs or convulsions)
• Severe gastrointestinal distress (i.e., unrelenting constipation, dry or hard bowel movements, nausea, vomiting, abdominal pain, bloating, and/or painful gas)
• Heart problems (i.e., chest pain, fast or pounding heartbeats, heart murmur or palpations, slow heartbeats, shortness of breath, and/or extreme dizziness)
• Liver problems (i.e., poor appetite, stomach pain, extreme fatigue, constant itching, dark-colored urine, clay-colored stools, and/or jaundice)
• Severe nervous system reaction (i.e., rigid muscles, high fevers, profuse sweating, mental confusion, fast or irregular heartbeats, tremors, and/or faintness)
• Blood clots in the lung (i.e., severe chest pain, sudden cough, wheezing, rapid breathing, and/or coughing up blood).

Note: Untreated constipation can lead to serious bowel complications, multiple hospitalizations, or death. So, if you are not having regular bowel movements, contact your doctor asap! Also, High doses of clozapine can increase your risk of seizures, so avoid any activity that could be dangerous, if you experience seizures or lose consciousness.

Moreover, high doses or long-term use of clozapine can lead to an irreversible movement condition. Understand that the longer you use clozapine, the higher the likelihood that you will develop this condition, especially if you are a female or older adult.

Is There Anything Else I Should Know Before Taking Clozapine for OCD?

Yes, there are some things you should be aware of before taking clozapine for OCD.

First, clozapine can lead to serious heart problems, especially if you take antibiotics for infections and/or medications for asthma, heart problems, high blood pressure, depression, mental illness, cancer, malaria, or HIV.

Second, combining clozapine with other medications may make you drowsy or lead to decreased breathing, which could, in rare cases, lead to death. So, consult your doctor before using opioids, sleep pills, muscle relaxers, cold and allergy meds, anxiety meds, antidepressants, or seizure meds.

Third, many prescription and over-the-counter medicines, vitamins, and herbal products can interact with clozapine. So, make sure that you tell your doctor and pharmacist about any medications, vitamins, or herbs you are taking before using this medication.

Fourth, clozapine interacts with your immune system. As a result, you may be at risk of getting recurrent infections – some of which could be fatal. Contact your doctor if you experience fevers, lethargy, muscle weakness, extreme fatigue, and/or sore throat.

Is There Anything Else I Should Avoid While Using Clozapine?

Yes, there are some things you should avoid while on this medication, such as:

• Drinking alcohol
• Caffeine (i.e., coffee, tea, cola, or energy drinks)
• Driving or performing any hazardous activity until you know how clozapine will affect you
• Getting up too fast from a sitting or lying down position

Also, let your doctor or pharmacist if you have one or more of the following conditions:

• Heart problems
• High blood pressure
• Heart attacks or strokes
• Long QT syndrome
• Electrolyte imbalance (i.e., low potassium or magnesium levels)
• Seizures
• Brain injury
• Brain tumor
• Diabetes
• High cholesterol or triglycerides
• Constipation or bowel movement issues
• Liver or kidney disease
• Enlarged prostate
• Urination problems
• Glaucoma
• Malnourishment or Dehydration

Note: Using antipsychotics during the last 3 months of pregnancy could cause breathing, feeding, and withdrawal symptoms in your newborn. You may also experience withdrawal symptoms if you suddenly stop clozapine without weaning off of it. Do not use this medication while breastfeeding because it could be transferred to your baby through your breastmilk. Lastly, do not use this medication if you suffer from dementia or if you are younger than 18.

Should I Take Clozapine for My OCD Symptoms?

It depends…

Some researchers have found that clozapine can cause or worsen OCD symptoms, while other researchers could not find a definitive link between clozapine and OCD-like symptoms or worsened OCD symptoms. Thus, the jury is still out as to if it could trigger or exacerbate OCD symptoms. Therefore, it is important to discuss the pros and cons of using clozapine for your OCD.

What Is It Like to Take Clozapine for OCD?

Listed below are user reviews for clozapine for OCD:

Melissa

“I ended up in the hospital for a complete OCD meltdown. I had not slept in days and was distraught. The hospital put me on clozapine 50mg for about 2 weeks because I needed to calm down while I underwent a medicine change. At first, I was terrified of being on a medication with such a severe reputation.

I was utterly shocked at the results; however, I calmed down almost immediately and did not suffer any weird side effects. My brain did not feel any slower or impaired on the dose I was on. I honestly did not feel any different other than being more mellow. Clozapine also helped me sleep. I wanted to stay on it, but the doctors ended up switching me to something more tolerable upon discharge.”

Chris

“Clozapine almost killed me. My white cell count was extremely low and I was getting fevers every other day. I also had severe diarrhea for almost a full year. I asked to stop the drug and I slowly got better. As much as this drug is praised, it is unnecessarily overprescribed. In some European countries, it is banned, and for good reason. My quality of life was horrible on this drug.

I gained weight and was constipated for a whole week. I also developed extreme OCD that dissipated as soon as the drug was stopped. I do not recommend clozapine for any mental health condition. You are better off turning to your local charity organization for help than getting involved with a doctor, who prescribes this medication without properly assessing your situation. Good luck.”

Are There Any Treatments, Natural Remedies, or Self-Help Tools That Can Help with My OCD Symptoms?

Yes, there are a variety of treatments (CBT, ACT, and/or ERP therapy), natural remedies, and self-help tools that you can use alone or in combination with your prescribed OCD treatment plan. A healthy diet, CBD, mindfulness meditation, regular exercise, books and apps on OCD, OCD support groups, OCD forums, hypnotherapy/hypnosis, acupuncture, vitamins, minerals, herbs, etc. Impulse Therapy is another self-help tool that can help treat your OCD. Impulse Therapy is an online OCD course designed to help you better manage your obsessions and/or compulsions, so you can live a more productive life.

• Eryılmaz, G., Hızlı Sayar, G., Ozten, E. et al. (2013). Aripiprazole augmentation in clozapine-associated obsessive-compulsive symptoms in schizophrenia. Ann Gen Psychiatry 12, 40. Retrieved from https://doi.org/10.1186/1744-859X-12-40
• Bleakley, S., Brown, D., & Taylor, D. (2011). Does clozapine cause or worsen obsessive-compulsive symptoms? An analysis and literature review. Therapeutic Advances in Psychopharmacology, 1(6), 181–188. Retrieved from https://doi.org/10.1177/2045125311425971
• Kim, D. D., Barr, A. M., White, R. F., Honer, W. G., & Procyshyn, R. M. (2019). Clozapine-induced obsessive-compulsive symptoms: Mechanisms and treatment. Journal of Psychiatry & Neuroscience, 44(1), 71–72. Retrieved from https://doi.org/10.1503/jpn.180087
• Grover, S., Hazari, N., Chakrabarti, S., & Avasthi, A. (2015). Relationship of obsessive-compulsive symptoms/disorder with clozapine: A retrospective study from a multispecialty tertiary care center. Asian Journal of Psychiatry, 15, 56–61. Retrieved from https://doi.org/10.1016/j.ajp.2015.05.002
• Ghaemi, S. N., Zarate, C. A., Jr, Popli, A. P., Pillay, S. S., & Cole, J. O. (1995). Is there a relationship between clozapine and obsessive-compulsive disorder? A retrospective chart review. Comprehensive Psychiatry, 36(4), 267–270. Retrieved from https://doi.org/10.1016/s0010-440x(95)90071-3
• Drugs.com. (2022). Clozapine. Retrieved from https://www.drugs.com/clozapine.html#dosage
• Raguraman, J., Vijay Sagar, K. J., & Chandrasekaran, R. (2005). Effectiveness of clozapine in treatment-resistant schizophrenia. Indian Journal of Psychiatry, 47(2), 102–105. Retrieved from https://doi.org/10.4103/0019-5545.55955
• Khokhar, J. Y., Henricks, A. M., Sullivan, E., & Green, A. I. (2018). Unique effects of clozapine: A pharmacological perspective. Advances in Pharmacology, 82, 137–162. Retrieved from https://doi.org/10.1016/bs.apha.2017.09.009
• Yuen, J., Kim, D. D., Procyshyn, R. M., White, R. F., Honer, W. G., & Barr, A. M. (2018). Clozapine-induced cardiovascular side effects and autonomic dysfunction: A systematic review. Frontiers in Neuroscience, 12, 203. Retrieved from https://doi.org/10.3389/fnins.2018.00203
• Ogbru, O. (n.d.). Clozapine. MedicineNet. Retrieved from https://www.medicinenet.com/clozapine/article.htm