Clomipramine | Selective Serotonin Reuptake Inhibitors | Comparative Efficacy of Potent SRIs
Numerous positive open trials of clomipramine in OCD were
followed by at least 22 controlled trials in which clomipramine
was either more effective (11 trials) than placebo or tricyclic
comparators or equally as effective as selective serotonin reuptake
inhibitor (SSRI) comparators (5 trials) (Greist et al. 1995).
Clinical opinion has generally led to dosing at the higher end of
the dosing range for these agents, although fixed-dose trials, when
available, have usually found a flat dose–response curve,
suggesting that many patients receive more medication than necessary.
Side effects of clomipramine are typical of a tricyclic antidepressant
and include anticholinergic, antihistaminergic, and alpha-adrenergic blocking