Anafranil Clomipramine

Tricyclic antidepressants, including Tofranil (imipramine) and Anafranil (clomipramine), usually intensify the effects of LSD. 

Anafranil (clomipramine) Asendin (amoxapine)4 Elavil (amitriptyline) Norpramin (desipramine) Pamelor (nortriptyline) Parnate (tranylcypromine)5 Sinequan (doxepin) Surmontil (trimipramine) Tofranil (imipramine) Vivactil (protriptyline)... 

Cognitive therapists feel it is important for OCD patients to learn to think differently in order to improve their condition. Most professionals who treat obsessive-compulsive illnesses feel that a combination of therapy and medication is helpful. Some antidepressants, like Anafranil (clomipramine) and Prozac (fluoxetine), are prescribed to help alleviate the condition. 

Tricyclic drugs have, as the name implies, a three-ring structure, and interfere with reuptake of norepinephrine and/or serotonin into axon terminals. Tricyclic drugs include imipramine (Tofranil), amitriptyline (Elavil), clomipramine (Anafranil), and nortriptyline (Pamelor, Aventil). Tricyclics have the occasional but unfortunate cardiovascular side effects of arrhythmia and postural hypotension. Newer, nontricyclic antidepressants have been developed that are collectively referred to as SSRIs. These have a potent and selective action on serotonin, and lack the cardiovascular side effects of the tricyclics. These include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and fluvoxamine (Luvox). A fifth SSRI, citalopram (Celexa) has been used in Europe and has recently been approved in the United States. Venlafaxine (Effexor) blocks reuptake of norepinephrine and serotonin, while bupropion (Wellbutrin) acts on both dopamine and norepinephrine. 

TCAs primarily work by blocking the reuptake of norepinephrine, although they block serotonin reuptake as well. The lone exception is clomipramine (Anafranil), which preferentially blocks serotonin reuptake. It is this unique characteristic that makes clomipramine the only TCA that effectively treats obsessive-compulsive disorder (OCD). 

Tricyclic Antidepressants (TCAs). The TCAs, particularly imipramine (Tofranil), were also discovered soon after their introduction to be effective in the treatment of panic attacks. Imipramine, the best-studied TCA in the treatment of panic disorder, is most often helpful at daily doses of 150-250 mg, though it must be started at 10-25 mg, usually at bedtime, and gradually increased over 2-4 weeks. Although they are not as well studied, many clinicians prefer to use the secondary amine TCAs, desipramine (Norpramin) and nortriptyline (Pamelor), because they have milder side effects than imipramine. Clomipramine (Anafranil), though probably the TCA with the greatest side effect burden, is often said to be most effective in patients with refractory disease. 

Clomipramine (Anafranil). Initially described as an effective treatment for OCD in the 1960s, clomipramine would later become the first FDA approved treatment for the disorder. To this day, it remains the best studied, and thereby the gold standard, treatment for OCD. Other TCAs have not proved effective for OCD. Because clomipramine is unique among the TCAs for particularly potent blockade of the... 

TCAs. Two tricyclics, clomipramine (Anafranil) and amitriptyline (Elavil), have been studied in AN. The obsessive preoccupation with food and body image pathognomonic of AN led clinicians to study clomipramine first, recognizing its well-documented efficacy for the treatment of OCD. Unfortunately, clomipramine did not successfully improve weight gain. Amitriptyline has been evaluated in AN studies with mixed results. 

Serotonin-Boosting Antidepressants. Antidepressants that enhance serotonin activity in the brain have also been studied in ADHD. In particular, fluoxetine (Prozac) and the serotonin-selective TCA clomipramine (Anafranil) have been the most extensively evaluated, with mixed success. They provide some benefit for aggression and impulsivity but don t significantly improve the poor attention of ADHD. As a result, the SSRls and other serotonin-boosting antidepressants do not appear to be effective first-line treatments for ADHD. Conversely, depressed patients without ADHD often show improvements in symptoms of concentration and attention when treated with a SSRI. Although SSRls are not widely used in the treatment of ADHD, they may be worthy of consideration in ADHD patients whose impulsivity is not controlled by stimulants alone. Those with comorbid conduct disorder or ODD who are prone to agitation and at times violent outbursts may be helped by the addition of a SSRI. 

Clomipramine (Anafranil) also a member of the tricyclic family, possesses similar pharmacology and antidepressant efficacy. This agent, however, has Food and Drug (FDA) approval only for use in the treatment of obsessive-compulsive disorder and is not included in this discussion of antidepressant drugs. 

Tricyclics Tertiary amine tricyclics Amitriptyline Clomipramine Elavil Anafranil 25-50 25 100-250 25, 50, 75 16 (27) 32 (69)... 

Clomipramine (generic, Anafranil labeled only for obsessive-compulsive disorder)... 

OFFICIAL NAMES Amitriptyline (Elavil), amoxapine (Asendin), bupropion (Wellbutrin), citalopram (Celexa), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), fluoxetine (Prozac), imipramine (Norfranil, Tofranil), isocarboxazid (Marplan), maprotiline (Ludiomil), mirtazapine (Remeron), nefazodone (Serzone), nortriptyline (Aventyl, Pamelor), paroxetine (Paxil), phenelzine (Nardil), protriptyline (Vivactil), sertraline (Zoloft), thioridazine (Mellaril), tranylcypromine (Parnate), trazodone (Desyrel), trimipramine (Sur-montil), venlafaxine (Effexor) the herb St. John s wort (Hypericum perforatum) is sold over-the-counter without prescription STREET NAMES Happy pills... 

Amitriptyline is usually the treatment of choice for neuropathic pain. Some selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac ),paroxetine (Paxil ),sertraline (Zoloft ), and clomipramine (Anafranil ) can be used, but they don t appear to be as effective as TCAs. The doses for TCAs in treating neuropathic pain are usually lower than those for treating depression, and the drugs usually start to take effect more quickly in relieving pain than they do in relieving depression. It is interesting that people who suffer from chronic pain often experience symptoms of depression, so TCAs can benefit these people by helping to ease not only their pain but also their depressed mood. 

The tricyclics, such as clomipramine (Anafranil), amitriptyline (Elavil), and imipramine (Tofranil), have been used for several decades. I have previously described their central nervous system toxic effects in some detail (Breggin, 1983b see also Breggin, 1991b). This section will therefore be abbreviated. A list of some of the older antidepressants can be found in the appendix. 

Capstick N. Psychiatric side-effects of clomipramine (Anafranil). J Int Med Res 1973 1 444. 

Haqqani MT, Gutteridge DR. Two cases of clomipramine hydrochloride (Anafranil) poisoning. Forensic Sci 1974 3(l) 83-7. 

Plasma levels for some psychotropic medications, certain correlations have been established between plasma levels (the concentration of a drug in the liquid portion of the blood) and therapeutic benefit. Using this method, the prescribing physician can make adjustments to the doses with the goal of reaching drug concentrations in the blood that are associated with optimal response. In a few instances—for example the antiobsessional clomipramine (trade name Anafranil) and the antide-... 

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