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How to treat OCD using clomipramine
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Mental & Emotional Health
Question #21953
96 days ago
208

How to treat OCD using clomipramine - #21953

Lolo

I'm a 29y old woman, I suffer from OCD from 10y ago, in July I started sertraline 50mg, then increased it to 75mg, with no improvement, a GP told me to take clomipramine in combination, but I was afraid from Serotonin syndrome, so I stopped sertraline gradually 3months ago, but I didn't start clomipramine yet, now I feel that I want to try it to treat my OCD

Age: 29
Chronic illnesses: No
300 INR (~3.53 USD)
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Doctors' responses

Dr. Prasannajeet Singh Shekhawat
I am a 2023 batch passout and working as a general physician right now, based in Hanumangarh, Rajasthan. Still kinda new in the bigger picture maybe, but honestly—every single day in this line teaches you more than textbooks ever could. I’ve had the chance to work under some pretty respected doctors during and after my graduation, not just for the clinical part but also to see how they handle people, real people, in pain, in panic, and sometimes just confused about their own health. General medicine covers a lot, right? Like from the smallest complaints to those random, vague symptoms that no one really understands at first—those are kinda my zone now. I don’t really rush to label things, I try to spend time actually listening. Feels weird to say it but ya, I do take that part seriously. Some patients just need someone to hear the whole story instead of jumping to prescription pads after 30 seconds. Right now, my practice includes everything from managing common infections, blood pressure issues, sugar problems to more layered cases where symptoms overlap and you gotta just... piece things together. It's not glamorous all the time, but it's real. I’ve handled a bunch of seasonal disease waves too, like dengue surges and viral fevers that hit rural belts hard—Hanumangarh doesn’t get much spotlight but there’s plenty happening out here. Also, I do rely on basics—thorough history, solid clinical exam and yeah when needed, investigations. But not over-prescribing things just cz they’re there. One thing I picked up from the senior consultants I worked with—they used to say “don’t chase labs, chase the patient’s story”... stuck with me till now. Anyway, still learning every single day tbh. But I like that. Keeps me grounded and kind of obsessed with trying to get better.
95 days ago
5

Hello Lolo It’s great that you’re seeking help for your OCD. Clomipramine is often used for OCD and can be effective, especially if SSRIs like sertraline haven’t worked for you.

Concerns About Serotonin Syndrome - It’s understandable to be cautious about serotonin syndrome, especially when combining medications. Clomipramine is a tricyclic antidepressant and can be used alongside SSRIs, but it’s important to follow your doctor’s guidance closely.

Next Steps

1. Start Slowly: If you decide to start clomipramine, I recommend starting at a low dose to see how you respond. 2. Monitor Symptoms: Keep track of any side effects or changes in your symptoms once you start the medication.

Keep eye on it and monitor your symptoms and report me after 15 days so that we can work on it.

Thank you and get well soon

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Starting with clomipramine, a tricyclic antidepressant, can be an effective option for obsessive-compulsive disorder (OCD), particularly if selective serotonin reuptake inhibitors (SSRIs) like sertraline haven’t provided the desired improvement. Clomipramine targets serotonin pathways differently, which can be beneficial for some people with OCD. Before you start clomipramine, ensure you discuss this with your GP to assess your current health status, any underlying conditions, or medications that might interact negatively. Starting doses are typically low, often around 25 mg per day, to minimize potential side effects and gradually increased based on tolerability and response. Monitoring is key, especially at the beginning, because side effects can include drowsiness, dry mouth, constipation, and dizziness, and rare cases of more severe effects like heart rhythm changes or seizures. Engaging in regular follow-ups helps in adjusting the dose safely and effectively. Be mindful of not consuming alcohol, as it can amplify side effects. Encourage lifestyle adjustments alongside medication, such as regular exercise and cognitive-behavioral therapy, which are proven to boost treatment outcomes for OCD. Stay transparent with your healthcare provider about any side effects or concerns. Overall, communication with your doctor is crucial for adjusting treatment based on how your condition evolves over time.

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Dr. Alan Reji
I'm Dr. Alan Reji, a general dentist with a deep-rooted passion for helping people achieve lasting oral health while making dental visits feel less intimidating. I graduated from Pushpagiri College of Dental Sciences (batch of 2018), and ever since, I've been committed to offering high-quality care that balances both advanced clinical knowledge and genuine compassion for my patients. Starting Dent To Smile here in Palakkad wasn’t just about opening a clinic—it was really about creating a space where people feel relaxed the moment they walk in. Dental care can feel cold or overly clinical, and I’ve always wanted to change that. So I focused on making it warm, easygoing, and centered completely around you. I mix new-age tech with some good old-fashioned values—really listening, explaining stuff without jargon, and making sure you feel involved, not just treated. From regular cleanings to fillings or even cosmetic work, I try my best to keep things smooth and stress-free. No hidden steps. No last-minute surprises. I have a strong interest in patient education and preventive dentistry. I genuinely believe most dental issues can be caught early—or even avoided—when patients are given the right information at the right time. That’s why I take time to talk, not just treat. Helping people understand why something’s happening is as important to me as treating what’s happening. At my practice, I’ve made it a point to stay current with the latest innovations—digital diagnostics, minimally invasive techniques, and smart scheduling that respects people’s time. I also try to make my services accessible and affordable, because good dental care shouldn’t be out of reach for anyone.
93 days ago
5

Clomipramine is one of the most effective medications for OCD, especially when SSRIs like sertraline haven’t helped, and since you stopped sertraline 3 months ago, the risk of serotonin syndrome from starting clomipramine now is very low. It’s important to start at a low dose and increase gradually, as clomipramine can cause side effects initially, but many patients do improve with proper dosing and time. Please consult a psychiatrist before starting it so they can prescribe the right dose, monitor side effects, and ideally combine it with CBT/ERP therapy, which gives the best long-term results for OCD.

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Dr. Arsha K Isac
I am a general dentist with 3+ years of working in real-world setups, and lemme say—every single patient teaches me something diff. It’s not just teeth honestly, it’s people… and how they feel walking into the chair. I try really hard to not make it just a “procedure thing.” I explain stuff in plain words—no confusing dental jargon, just straight talk—coz I feel like when ppl *get* what's going on, they feel safer n that makes all the difference. Worked with all ages—like, little kids who need that gentle nudge about brushing, to older folks who come in with long histories and sometimes just need someone to really sit n listen. It’s weirdly rewarding to see someone walk out lighter, not just 'coz their toothache's gone but coz they felt seen during the whole thing. A lot of ppl come in scared or just unsure, and I honestly take that seriously. I keep the vibe calm. Try to read their mood, don’t rush. I always tell myself—every smile’s got a story, even the broken ones. My thing is: comfort first, then precision. I want the outcome to last, not just look good for a week. Not tryna claim perfection or magic solutions—just consistent, clear, hands-on care where patients feel heard. I think dentistry should *fit* the person, not push them into a box. That's kinda been my philosophy from day one. And yeah, maybe sometimes I overexplain or spend a bit too long checking alignment again but hey, if it means someone eats pain-free or finally smiles wide in pics again? Worth it. Every time.
96 days ago
5

Hello,

Clomipramine is effective for OCD, but it should be started alone (not with sertraline) to avoid serotonin syndrome — you did the right thing by stopping sertraline first.

How it is usually started: Start clomipramine 25 mg at night Increase slowly every 5–7 days (25 → 50 → 75 mg) Typical effective dose: 100–150 mg/day (sometimes lower works) Improvement takes 4–6 weeks, full benefit up to 10–12 weeks

Common side effects: sleepiness, dry mouth, constipation, dizziness

Important precautions: Avoid combining with SSRIs ECG may be advised before higher doses Do not stop suddenly

Best results: Clomipramine + CBT (ERP therapy)

Please start this under psychiatrist supervision, especially for dose increases.

I trust its clear Thank you !

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Dr. Shayeque Reza
I completed my medical degree in 2023, but honestly, my journey in healthcare started way before that. Since 2018, I’ve been actively involved in clinical practice—getting hands-on exposure across multiple departments like ENT, pediatrics, dermatology, ophthalmology, medicine, and emergency care. One of the most intense and defining phases of my training was working at a District Government Hospital for a full year during the COVID pandemic. It was chaotic, unpredictable, and exhausting—but it also grounded me in real-world medicine like no textbook ever could. Over time, I’ve worked in both OPD and IPD setups, handling everything from mild viral fevers to more stubborn, long-term conditions. These day-to-day experiences really built my base and taught me how to stay calm when things get hectic—and how to adjust fast when plans don’t go as expected. What I’ve learned most is that care isn't only about writing the right medicine. It’s about being fully there, listening properly, and making sure the person feels seen—not just treated. Alongside clinical work, I’ve also been exposed to preventive health, health education, and community outreach. These areas really matter to me because I believe real impact begins outside the hospital, with awareness and early intervention. My approach is always centered around clarity, empathy, and clinical logic—I like to make sure every patient knows exactly what’s going on and why we’re doing what we’re doing. I’ve always felt a pull towards general medicine and internal care, and honestly, I’m still learning every single day—each patient brings a new lesson. Medicine never really sits still, it keeps shifting, and I try to shift with it. Not just in terms of what I know, but also in how I listen and respond. For me, it’s always been about giving real care. Genuine, respectful, and the kind that actually helps a person heal—inside and out.
96 days ago
5

You have a long-standing obsessive–compulsive disorder (OCD) that did not adequately respond to sertraline. Since you have completely stopped sertraline for 3 months, there is no risk of serotonin syndrome from starting clomipramine now. Clomipramine is an effective and evidence-based treatment for OCD, especially when SSRIs are ineffective. It can be started safely at a low dose and increased gradually under medical supervision. Combining medication with cognitive behavioral therapy (CBT), particularly exposure and response prevention (ERP), offers the best chance of improvement. With proper dosing and monitoring, clomipramine can significantly reduce OCD symptoms and improve quality of life.

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Dr. Bharat Joshi
I’m a periodontist and academician with a strong clinical and teaching background. Over the last 4 years and 8 months, I’ve been actively involved in dental education, guiding students at multiple levels including dental hygienist, BDS, and MDS programs. Currently, I serve as a Reader at MMCDSR in Ambala, Haryana—a role that allows me to merge my academic passion with hands-on experience. Clinically, I’ve been practicing dentistry for the past 12 years. From routine procedures like scaling and root planing to more advanced cases involving grafts, biopsies, and implant surgeries. Honestly, I still find joy in doing a simple RCT when it’s needed. It’s not just about the procedure but making sure the patient feels comfortable and safe. Academically, I have 26 research publications to my credit. I’m on the editorial boards of the Archives of Dental Research and Journal of Dental Research and Oral Health, and I’ve spent a lot of time reviewing manuscripts—from case reports to meta-analyses and even book reviews. I was honored to receive the “Best Editor” award by Innovative Publications, and Athena Publications recognized me as an “excellent reviewer,” which honestly came as a bit of a surprise! In 2025, I had the opportunity to present a guest lecture in Italy on traumatic oral lesions. Sharing my work and learning from peers globally has been incredibly fulfilling. Outside academics and clinics, I’ve also worked in the pharmaceutical sector as a Drug Safety Associate for about 3 years, focusing on pharmacovigilance. That role really sharpened my attention to detail and deepened my understanding of drug interactions and adverse effects. My goal is to keep learning, and give every patient and student my absolute best.
95 days ago
5

Hello dear See as per clinical history clomipramine is recommended. It is also comparatively safer. It should be started with single dose of 25 mg. It should be increased gradually. However in case of allergy some alternative medicine should be used. I suggest you to please get in person consultation with neurologist or concerned about for better clarity and safety Regards

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