Depression clomipramine

Besides depression, clomipramine is also widely used in the treatment of phobic and obsessive-compulsive disorders (6-8) and in panic disorders (9). 

Tricyclic antidepressants (TCAs) Clomipramine Doxepin Imipramine Lofepramine Nortriptyline Trimipramine (Amitriptyline, Dosulepin) Nocte See BNF See BNF See BNF For depression clomipramine used in OCD Liquids and tablets available Very toxic in overdose (amitriptyline and dosulepin no longer recommended for depression due to OD risk) Caution in CVD and many physical conditions Tolerance to side effects may develop Anticholinergic side effects ... 

Elsenga S., van den Hoofdakker R. H. (1993). Clinical effects of sleep deprivation and clomipramine in endogenous depression. J. Psychiatr. Res. 17, 361-74. 

Larsen, J. K., Gjerris, A., Holm, P. etal. Moclobemide in depression a randomized, multicentre trial against isocar-boxazide and clomipramine emphasizing atypical depression. Acta Psychiatr. Scand. 84 564-570,1991. 

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. 

Relief of symptoms of depression (except clomipramine). The activating properties of protriptyline make it particularly suitable for withdrawn and anergic patients. Agents with significant sedative action may be useful in depression associated with anxiety and sleep disturbances. The activating properties of protriptyline make it particularly suitable for withdrawn and anergic patients. 

Other innovative treatments such as intravenous clomipramine (CMI) and TMS have been used for the treatment of depressed adults who have not responded to standard treatment. In adolescents, intravenous clomipramine has been shown to be efficacious for patients who have failed to respond to other antidepressant treatments (Sallee et al., 1997). 

Sallee, F.R., Vrindavanam, N.S., Deas-Nesmith, D., Carson, S.W., and Sethuraman, G. (1997) Pulse intravenous clomipramine for depressed adolescents a double-blind, controlled trial. Am J Psychiatry 154 668-673. 

A potential limitation of most of the controlled studies discussed above relates to the numerous exclusion criteria used for patient selection. For example, in order to find homogenous samples, major depression, bipolar disorder, Tourette s disorder, psychosis (clomipramine, fluvoxamine and fluoxetine trials), primary psychiatric disorder other than OCD (clomipramine and sertraline trials), and attention deficit/hyperactivity disorder (ADHD), autism, or other developmental disorders (clomipramine and fluoxetine trials) were excluded. Thus it remains unknown how well these controlled studies will generalize to more naturalistic clinical populations that are highly comorbid and where exclusion criteria are not applied. 

Tricyclic antidepressants have been used for decades to treat depression and anxiety in the general population, and clomipramine has been used to treat OCD. Clomipramine has been studied with respect to treating school phobia or school refusal (Berney et ah, 1981). Gittleman-Klein and Klein (1971) found imipramine to be superior to placebo in treating school refusal. As the TCAs may improve other disorders such as nocturnal enuresis, ADHD, and sleep disorders, they may be attractive for children with any of these comorbid conditions and anxiety disorder. 

In 1995, Bramble published a study on the prescription frequency of antidepressants by British child psychiatrists (Bramble, 1995). A brief postal questionnaire was circulated to 350 members of the British Royal College of Psychiatrists, Child and Adolescent Psychiatry Specialist Sections. There was a 71% response rate, and 85% of the 238 respondents had employed antidepressants, the most popular of these being amitriptyline and imipramine. Nearly one-third of the psychiatrists at that time used neuroagents occasionally, and the SSRIs were used only very rarely. The antidepressant medication was used for a wide range of child and adolescent disorders beyond those of depression and nocturnal enuresis. Approximately 20% of the prescriptions were given for ADHD (hyperkinetic disorder), conduct disorder, and a few cases of autistic disorder. Clomipramine was apparently given for OCD. On the basis of these 1994 data. Bramble concluded that British child psychiatrists tend to use antidepressant medication far less often than American psychiatrists. 

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Riemann D, Berger M The effects of total sleep deprivation and subsequent treatment with clomipramine on depressive symptoms and sleep electroencephalography in patients with a major depressive disorder. Acta Psychiatr Scand 81 24-31, 1990... 

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