Clomipramine use in obsessive–compulsive disorder

The serotonin reuptake inhibitor, clomipramine and newer selective serotonin reuptake inhibitors have become recognized as the most effective monotherapy for obsessive-compulsive disorder. Meta-analyses have suggested that clomipramine may be superior to other selective serotonin reuptake inhibitors in treating obsessive-compulsive disorder. Double-blind, direct comparisons of the selective serotonin reuptake inhibitors and clomipramine, have demonstrated equal efficacy, fewer side effects and lower medication discontinuation rates in selective serotonin reuptake inhibitor patients. However, clomipramine continues to play a vital role in the pharmacotherapy of obsessive-compulsive disorder, being used when two or more selective serotonin reuptake inhibitor trials have not been sufficiently effective, which can occur in up to a third of patients. Recent investigation suggests potential roles for intravenous clomipramine and the combination of oral clomipramine with selective serotonin reuptake inhibitors and other medications in treatment-refractory obsessive-compulsive disorder patients.