Clomipramine

Class & Mechanism

Clomipramine is a tricyclic antidepressant (TCA) with potent serotonergic activity. Its strong inhibition of serotonin reuptake gives it unique anti-obsessional properties that distinguish it from other TCAs, making it the TCA of choice for obsessive-compulsive symptoms.

Indications

• Obsessive type of morbid-jealousy — where the jealous thoughts are intrusive, repetitive, and recognised by the patient as irrational (as opposed to the delusional type where antipsychotics such as risperidone are used).
• Obsessive-compulsive disorder (OCD).

📝 TODO: Needs source — specific indications, dosing protocols, evidence base for morbid jealousy.

Dosage

📝 TODO: Needs source — starting dose, titration schedule, therapeutic range, maximum dose.

Side Effects

As a TCA, clomipramine shares the typical side effect profile of this class:

• Anticholinergic — dry mouth, blurred vision, constipation, urinary retention.
• Cardiac — prolonged QT interval, arrhythmia risk in overdose.
• Sedation — particularly at the start of treatment.
• Weight gain.
• Seizures — risk is higher with clomipramine than with other TCAs, especially at high doses.

📝 TODO: Needs source — specific side effect incidence, overdose toxicity.

Contraindications

📝 TODO: Needs source — cardiac disease, recent myocardial infarction, epilepsy, narrow-angle glaucoma, concurrent monoamine oxidase inhibitor (MAOI) use.

Drug Interactions

📝 TODO: Needs source — interactions with other serotonergic drugs (risk of serotonin syndrome), monoamine oxidase inhibitors (MAOIs), alcohol.

Sri Lanka Availability

📝 TODO: Needs source — availability in Sri Lankan government hospitals.

Exam Focus

Viva Questions

• What class of drug is clomipramine? (Tricyclic antidepressant.)
• When is clomipramine used in morbid jealousy? (For the obsessive type, where the patient has insight and the thoughts are intrusive — as opposed to the delusional type treated with antipsychotics.)
• What distinguishes clomipramine from other TCAs? (Its potent serotonergic activity gives it anti-obsessional properties.)

MCQ Traps

• ⚠️ EXAM DETAIL: Clomipramine is a TCA, not a selective serotonin reuptake inhibitor (SSRI), but it has strong serotonergic activity that makes it effective for obsessive symptoms.
• ⚠️ EXAM DETAIL: Seizure risk is higher with clomipramine than with other TCAs.
• ⚠️ EXAM DETAIL: Treatment choice in morbid-jealousy depends on the psychopathological type — antipsychotics for delusional, clomipramine/fluoxetine for obsessive.

Source Notes

• Information in this page is drawn from the management discussion in morbid-jealousy, which is sourced from the Handbook of Clinical Psychiatry (de Silva & Hanwella).