Clomipramine, a tricyclic antidepressant, is an OCD medication that works by reducing symptoms of obsessions and compulsions. However, it’s important to consider the time it takes for the medication to work and the potential side effects associated with its use.
Exposure and response prevention (ERP) therapy and medication have been proven to be the most effective treatments for obsessive-compulsive disorder (OCD) .
ERP is a specialized form of cognitive behavioral therapy (CBT) designed to treat OCD. While ERP works by disrupting the cycle of obsessions and compulsions through structured behavioral exercises, medications can ease the intensity of OCD symptoms.
Of the many medications often prescribed for OCD, clomipramine is one of the oldest and the first to be approved by the FDA for treating obsessive-compulsive disorder.
In this article, we’ll explain how clomipramine works, when it might be recommended as part of OCD treatment, dosage and potential side effects, and what to consider before starting it.
How clomipramine is used to treat OCD
Clomipramine, also known by the brand name Anafranil, belongs to a class of drugs called tricyclic antidepressants (TCAs). What sets clomipramine apart from other TCAs is its unique receptor profile, which more closely resembles that of an SSRI (selective-serotonin reuptake inhibitor). This makes it especially effective for managing OCD symptoms compared to other medications in its class.
Antidepressants are designed to reduce or alleviate symptoms of depression, anxiety, OCD, and other mental health conditions by influencing the balance of chemicals in the brain. Tricyclic antidepressants, named for their three-ring chemical structure, enhance neurotransmission in brain cells that use serotonin and norepinephrine. These chemicals play a role in regulating your mood, anxiety, and other emotions. Among other effects, clomipramine blocks the reuptake of serotonin and norepinephrine.
Normally, after these chemicals are released into the space between nerve cells, they are reabsorbed. By slowing this reabsorption process, clomipramine allows serotonin and norepinephrine to remain active between nerve cells for a longer period.
Gradually, over several weeks, this works to enhance the communication in these nerve cells. This helps reduce symptoms of depression, anxiety, and helps lessen the intensity and frequency of obsessions and compulsions in people with OCD.
Clomipramine dosage for OCD
According to Jamie Feusner, MD, Professor of Psychiatry at the University of Toronto and Chief Medical Officer at NOCD, the dose range for most adults for treating OCD with clomipramine is 150mg to 250mg, with a suggested maximum dose of 250mg.
An advantage of clomipramine is that blood levels can be measured, which can help guide treatment in terms of whether a person is getting a therapeutic dosage and making sure the levels are not too high, as it might cause significant side effects.
How long does it take for clomipramine to start working?
SSRIs are often prescribed as a first-line medication because of their effectiveness and generally preferable side effect profile. SSRIs commonly prescribed for OCD include fluoxetine (Prozac), fluvoxamine (Luvox), escitalopram (Lexapro), sertraline (Zoloft), and paroxetine (Paxil).
Clomipramine is often recommended as a second-line medication when SSRIs fail to provide relief or are not well-tolerated. Clomipramine’s mechanism of action, while similar to SSRIs, includes effects on other neurotransmitter systems other than primarily serotonin (such as norepinephrine) which is why it might work better for some who don’t respond to an SSRI.
In some cases, clomipramine may be prescribed as an augmenting agent—a secondary medication added to an existing form of treatment (typically, an SSRI) to enhance its effectiveness. Gauging an SSRI’s effectiveness can take anywhere from six weeks to 12 weeks, though things may continue to improve for many weeks or even months after that.
Side effects
As with any medication, clomipramine can cause side effects. While the following is not an exhaustive list, some of the most common side effects include:
- Weight gain
- Dry mouth
- Constipation
- Sexual side effects (prolonged time to orgasm)
- Low blood pressure
While SSRIs may cause similar side effects, they are generally considered to be tolerated better.
Taking clomipramine (as well as any other psychiatric medication) should always be carefully monitored by your prescriber, especially during the first few weeks. Let your prescriber know if you are experiencing any side effects or sudden changes in your mood. It is important that your prescriber monitor the blood levels to help guide the dosage.
Is clomipramine right for me?
Psychiatric medication recommendations will depend on your age, health history, what other medications you take, and factors such as pregnancy and breast/chestfeeding. The best way to find out if clomipramine makes sense for your OCD treatment is by speaking with your healthcare provider.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Combining clomipramine with ERP therapy
While many medications can be an effective treatment option for OCD on their own, the best results are often seen when they are combined with exposure and response prevention therapy. ERP is a behavioral therapy that works by breaking the cycle of obsessions and compulsions, and it has been shown to help up to 80% of the people who use it.
When used on their own, medications only treat OCD’s symptoms, whereas ERP helps foster long-term recovery by helping you resist performing compulsions. Some people find it helpful to reduce (but not eliminate) their anxiety and distress through medication before starting ERP, but the right approach varies depending on the individual’s needs and treatment plan.
Bottom line
Every treatment plan is unique, and finding the right medication, or combination of medications, requires both time and patience. If you’re considering OCD medication as part of your treatment plan, speak with a licensed healthcare professional.
Key takeaways
- Clomipramine is a tricyclic antidepressant effective in reducing OCD symptoms, especially when SSRIs are not sufficient.
- The medication works primarily by enhancing serotonin and norepinephrine activity in the brain, which reduces obsessions and compulsions, and can improve mood.
- For some people, combining clomipramine with exposure and response prevention (ERP) therapy may lead to positive long-term outcomes.