Clomipramine: Uses, Alternatives, and What You Need to Know

When you hear clomipramine, a tricyclic antidepressant originally developed for depression but now widely used for obsessive-compulsive disorder. Also known as Anafranil, it’s one of the few medications approved by the FDA specifically for OCD. Unlike newer SSRIs, clomipramine works on multiple brain chemicals at once—serotonin and norepinephrine—which makes it effective for stubborn cases where other drugs fail. But it’s not a first-line choice for everyone. Its side effect profile is heavier, and it requires careful monitoring.

Clomipramine is often compared to other tricyclic antidepressants, a class of older antidepressants including amitriptyline, nortriptyline, and imipramine, but it stands out because of its strong serotonin action. That’s why it’s frequently chosen for OCD, while others like amitriptyline are better for chronic pain or sleep issues. People who’ve tried SSRIs like fluoxetine or sertraline without success often turn to clomipramine. But it’s not a magic bullet—it can cause dry mouth, dizziness, weight gain, and in rare cases, heart rhythm problems. That’s why doctors usually start low and go slow.

There’s also a growing interest in how clomipramine stacks up against newer options like SSRIs, selective serotonin reuptake inhibitors such as fluvoxamine, which is also FDA-approved for OCD. Some studies show fluvoxamine works just as well with fewer side effects, but clomipramine still has a place—especially when symptoms are severe or when patients don’t respond to anything else. It’s also used off-label for panic disorder, chronic pain, and even some forms of depression that don’t budge with standard treatments.

If you’re considering clomipramine, you’re not just choosing a drug—you’re weighing trade-offs. It’s powerful, but it demands attention. You’ll need regular check-ups, especially for heart health. You can’t just stop it cold turkey. And you’ll likely need to try a few different doses before finding the sweet spot. The good news? For many people, it’s the one thing that finally brings relief when everything else has failed.

Below, you’ll find real comparisons and insights from people who’ve walked this path—whether they switched from SSRIs, battled side effects, or found clomipramine to be their turning point. These aren’t generic summaries. They’re practical stories from real users and clinicians, covering what works, what doesn’t, and what to watch out for.