Clomipramine

Clomipramine

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Tricyclic antidepressant (TCA) Can Be Addictive Some Abuse Potential High Weight Gain Risk
Sedating: Can be Driving: Caution QT risk: Moderate Akathisia: Low Metabolic: Moderate Prolactin: Low ACB: 3 t½: 32 h Tmax: 4 h

The “OCD TCA.” Clomipramine is one of the few antidepressants that actually has proper evidence for obsessive thoughts. It’s strong on serotonin, but that also means gnarly side effects: sedation, constipation, sweats, and sexual dysfunction that make SSRIs look polite. If SSRIs don’t cut it for intrusive thoughts, psychiatrists sometimes dig this one out of the back cupboard. Powerful, but definitely not gentle.

Uses • Warnings

🩺 Main Uses

Obsessive-compulsive disorder; depression; panic disorder.

🧪 The Science & Facts

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Half‑life (t½)

32 h

How long the drug hangs around. Longer half‑life = slower changes.

Time to Peak (Tmax)

4 h

Roughly when you feel the main effect after a dose.

What it hits (receptors)

Primary:

SERT (potent reuptake inhibitor)NET (moderate reuptake inhibitor)H1 (antagonist)M1 (antagonist)alpha1 (antagonist)

Strongest SERT binding among TCAs; gold-standard for OCD.

How your body processes it (metabolism)

Substrate: CYP2D6Substrate: CYP2C19

Strong interactions possible; variable metabolism.

⚠️ Warnings

  • High anticholinergic burden • QT/seizure risk at higher doses • Titrate slowly; monitor levels/interactions if available

⏬ Taper & Withdrawal

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If you’re reducing

Withdraw gradually; relapse of OCD common if abrupt.

Possible withdrawal

Rebound anxiety, insomnia, cholinergic symptoms.

Info here is educational, not medical advice. Always taper with prescriber support if possible.

🧠 Trusted External Sources Last reviewed 22 Aug 2025, 21:03 by Connor O’Driscoll

Drugs.com

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NHS

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🔗 Interaction Checker

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⚠️ Black Box Warning

All antidepressants: ↑ suicidal thoughts/behaviours in under-25s.

This is a plain‑English summary of headline safety warnings. Talk to a clinician before changing any medication.

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