Psycho-Babble Medication Thread 1097186

Shown: posts 1 to 15 of 15. This is the beginning of the thread.

 

Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by Hordak on March 5, 2018, at 14:47:49

I've been reading the following articles:

http://psychotropical.info/clomipramine-potent-snri-anti-depressant/
http://psychotropical.info/tca-intro/
http://psychotropical.info/snri-intro/

Seems to be a pretty potent drug: SNRI, antagonist of the alpha1-adrenergic receptor, the histamine H1 receptor, the serotonin 5-HT2A, 5-HT2C receptors, the dopamine D1, D2, and D3 receptors, and the muscarinic acetylcholine receptors. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system; so that speaks for itself.

The reviews on drugs.com and other sites also are quite positive: http://www.drugs.com/comments/clomipramine/

The following ranking is interesting: http://slatestarcodex.com/2015/04/30/prescriptions-paradoxes-and-perversities/

These numbers are based on aggregated patient ratings. Top 4 drugs:
# Nardil 1.25
# Parnate 1.23
# Chlomipramine 1.22
# Emsam/selegeline 1.07

=> Clomipramine roughly on pair with MAOI, followed by Nefazodone (R.I.P) and Imipramine. Imipramine is also a potent SNRI, but lacks the strong 5HT-antagonism compared to Clomipramine. I suppose that's the pharmacological difference which makes Clomipramine superior... ?

Clomipramine exhibits some antagonism of dopamine D1, D2 and D3 receptors... can one expect some clinical & therapeutic benefits from this?

Clomipramine acts as a functional (potent!) inhibitor of acid sphingomyelinase (FIASMA): http://en.wikipedia.org/wiki/FIASMA
Some interesting graphs regarding antidepressant FIASMAs: http://d-nb.info/1011278227/34

Who here has been on Clomipramine and what were your experiences with it?

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by Hordak on March 5, 2018, at 14:50:57

In reply to Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by Hordak on March 5, 2018, at 14:47:49

α1-adrenergic receptor ;=)

(sorry for the formatting problem)

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by Hordak on March 5, 2018, at 14:51:36

In reply to Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by Hordak on March 5, 2018, at 14:47:49

alpha1-adrenergic receptor ;=)

(sorry again for the formatting problem)

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by joe f on March 5, 2018, at 15:38:50

In reply to Re: Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by Hordak on March 5, 2018, at 14:51:36

have you ever seen head to head studies with Clomipramine and luvox and their efficacy.

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by Hordak on March 5, 2018, at 16:04:34

In reply to Re: Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by joe f on March 5, 2018, at 15:38:50

no!
Did you?

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by Hugh on March 6, 2018, at 14:01:25

In reply to Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by Hordak on March 5, 2018, at 14:47:49

> Who here has been on Clomipramine and what were your experiences with it?

I had a lot of difficulty concentrating while I was on it. I don't think I had a sexual thought while I was on it.

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by Hordak on March 6, 2018, at 17:28:04

In reply to Re: Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by Hugh on March 6, 2018, at 14:01:25

Did it help you with whatever you have?

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by Hugh on March 6, 2018, at 22:33:56

In reply to Re: Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by Hugh on March 6, 2018, at 14:01:25

It was harder to ruminate while I was on it, because I would keep losing my train of thought.

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by Christ_empowered on March 7, 2018, at 11:22:26

In reply to Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by Hordak on March 5, 2018, at 14:47:49

this is interesting. I'm into Orthomolecular, on top of "standard treatment."

Anyway, Dr.Abram Hoffer and some other Orthomolecular psychiatrists reported very good results using vitamins, relatively low dose neuroleptics, and clomipramine in the treatment of what they termed "The Schizophrenias" (which would include a lot of personality disorder people, Bipolar I people, and psychotic depression people under mainstream diagnostic criteria).

Hoffer wrote something like "its hard to find a cheerful Schizophrenic," so he tried to minimize the neuroleptic (to avoid the "tranquilizer psychosis"), adjust the supplements, and make use of antidepressants to get better results than many of his mainstream peers.

I personally don't have any experience. I briefly took Tofranil a while back, but it was rough going.

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by Hordak on March 7, 2018, at 12:44:21

In reply to Re: Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by Christ_empowered on March 7, 2018, at 11:22:26

"I personally don't have any experience. I briefly took Tofranil a while back, but it was rough going."

how so?

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by Christ_empowered on March 7, 2018, at 12:53:17

In reply to Re: Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by Hordak on March 7, 2018, at 12:44:21

hi. at first, I was happy about the Tofranil. The psychiatrist prescribed 150mgs from day 1, all of which was to be taken at night, 1 dose (at my pharmacy, that mean 3 fifty mg tablets).

I hadn't been sleeping so well, so the sedative effect was -much- appreciated. However, the dry mouth, day time grogginess, and inability to drop weight (I was briefly on Atkins, and I lost 0lbs, whereas in years past, Atkins had been effective) did not sit well with me.

then i had a new shrink at the clinic (they come and go), and he said he'd prefer something "more modern." I ended up on a low dose of Lamictal and then wellbutrin, also.

I -will- say that I was far less apathetic on Tofranil than on Cymbalta, and it covered a lot of bases (sleep, ruminations, concentration).

oh, and the other thing...my official, current label/diagnosis is Bipolar I, mostly (severe) depression, and TCA drugs are increasingly frowned upon for Bipolar I people...or so says the current psychiatrist.

I do think Tofranil could be a good option, as long as you aren't prone to ODs, you watch the drug-drug interactions, and you don't have heart problems.

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by Ruuudy on March 7, 2018, at 16:09:26

In reply to Re: Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by Christ_empowered on March 7, 2018, at 12:53:17

> I ended up on a low dose of Lamictal and then wellbutrin, also.
>

Hi Christ Empowered!
How did you like the Wellbutrin?
I was so hopeful it was gonna give me the benefits of what so many describe - more "pep in my step", more motivation, more energy; but it actually gave me the opposite effects.

Had to drop it after more than 8 weeks at the 300mg dose.

Rudy
Prozac/fluoxetine 25+ Years Club Member

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD? Ruuudy

Posted by SLS on March 7, 2018, at 18:19:10

In reply to Re: Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by Ruuudy on March 7, 2018, at 16:09:26

Hi, Ruuudy.

> I was so hopeful it was gonna give me the benefits of what so many describe - more "pep in my step", more motivation, more energy; but it actually gave me the opposite effects.

I reacted to Wellbutrin in a similar way. It made me more depressed and very dysphoric.


- Scott

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by Christ_empowered on March 7, 2018, at 18:32:10

In reply to Re: Clomipramine | The 'Gold Standard' for MDD + OCD? Ruuudy, posted by SLS on March 7, 2018, at 18:19:10

I started at 200mgs/Wellbutrin, and then the shrink doubled it to 400. It was OK, for a while. Didn't help much with ruminations, but I ate a bit less and could concentrate a bit better. I think it boosted the Abilify blood levels a bit too much.

Eventually, I just...dropped it. Kinda tired for a couple days, not major discontinuation problems. I actually felt better off it...I'd worked out some psychosocial stuff, plus...although I wasn't -as- apathetic on wellbutrin as on ssri, ssnri drugs, it did have some emotional numbing going on.

 

Re: Clomipramine | The 'Gold Standard' for MDD + OCD?

Posted by bleauberry on March 9, 2018, at 10:55:15

In reply to Clomipramine | The 'Gold Standard' for MDD + OCD?, posted by Hordak on March 5, 2018, at 14:47:49

One thing I am discovering in my continued studies of microbial causes of psychiatric symptoms is that some of our meds and substances have some fairly potent antimicrobial action which may be responsible for some of the anti depressive traits we see once in a while. A previous poster here - Jereon - experienced remarkable relief from Seroquel - which as it turns out has fairly strong antibacterial qualities. A supplement sometimes used for depression - I recall SLS tried this once - NAC (N-aacetyl-cysteine) is potent against Clamydia, which causes psychiatric symptoms.

So I often wonder if this angle has anything to do with some antidepressants being perceived as being better than others. Personally I think it has more to do with the blocking of various receptors - agonism and antagonism - which helps to disrupt the toxins of infection/inflammation which are causing the psychiatric symptoms.

I've been on every psychiatric med known to man, with the exception of a small handful. My best was Prozac+Zyprexa+Modafinil.

Second best was Parnate.

Clomipramine has a good reputation but the side effects are not tolerable to most people. The drug is not likely to push back against the actual cause of the mood problems. But it makes as decent a bandaid as anything else I guess, if you can handle the side effects.


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