Posted by Ame Sans Vie on July 26, 2003, at 11:39:16
In reply to Re: KLONOPIN FOR OCD?, posted by matthhhh on July 26, 2003, at 7:27:30
Anafranil (clomipramine), along with Luvox, is considered a first-line medication for OCD. I've heard it often helps greatly when the SSRIs fail. However, you should be aware that the incidence of side effects with clomipramine is about the same as with most SSRIs (i.e. sexual dysfunction, apathy), except the sedation is a lot worse on clomipramine for most people.
Here's a basic rundown of the anti-obsessional medications and their side effect profiles:
ANTI-OBSESSIONAL DRUG PROPERTIES
ANAFRANIL
Dosage Range: 150-250 mg
Sedation: High
Anticholinergia: High
Action on Norepinephrine (0-5): 0
Action on Serotonin (0-5): 5
Action on Dopamine (0-5: 0
Most Common Side Effects: dizziness, tremors, mania, drowsiness, aggressiveness, constipation, dry mouth, nausea, dyspepsia, delayed ejaculation, anorgasmia, urinary retentionPROZAC*
Dosage Range: 20-80 mg
Sedation: Low
Anticholinergia: None
Action on Norepinephrine (0-5): 0
Action on Serotonin(0-5): 5
Action on Dopamine (0-5): 0
Most Common Side Effects: Headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, fatigue, sedation, poor concentration, abnormal dreams, agitation, hot flashes, palpitations, nausea, diarrhea, dry mouth, anorexia, dyspepsia, constipation, cramps, vomiting, taste changes, flatulence, decreased appetite, dysmenorrhea, decreased libido, urinary frequency, urinary tract infection, sweating, rash, pruritus, pain, infrection, pharyngitis, nasal congestion, sinus headache, sinusitis, cough dyspnea, bronchitis, asthenia, viral infections, fever, allergy, chillsZOLOFT*
Dosage Range: 50-200mg
Sedation: Low
Anticholinergia: None
Action on Norepinephrine (0-5): 0
Action on Serotonin (0-5): 5
Action on Dopamine (0-5): 0
Most Common Side Effects: insomnia, agitation, somnolence, dizziness, headache, tremor, fatigue, diarrhea, nausea, constipation, anorexia, dry mouth, vomiting, flatulence, male sexual dysfunctionPAXIL*
Dosage Range: 20-60 mg
Sedation: Low
Anticholinergia: Low
Action on Norepinephrine (0-5): 1
Action on Serotonin (0-5): 5
Action on Dopamine (0-5): 0
Most Common Side Effects: headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, fatigue, sedation, nausea, diarrhea, constipation, dry mouth, anorexia, abnormal ejaculation, male genital disordersLUVOX*
Dosage Range: 50-300 mg
Sedation: Low
Anticholinergia: Low
Action on Norepinephrine (0-5): 0
Action on Serotonin (0-5): 5
Action on Dopamine (0-5): 0
Most Common Side Effects: amnesia, apathy, hyperkinesia, hypokinesia, manic reaction, nyoclonus, psychotic reaction, malaise, hypertension, hypotension, syncope, tachycardia, elevated liver transaminases, edema, weight gain, weight loss, libido decreased, sexual dysfunction, impotence, anorgasmia, cough increased, sinusitis, accidental injury,CELEXA*
Dosage Range: 10-60 mg
Sedation: Low
Anticholinergia: None
Action on Norepinephrine (0-5): 0
Action on Serotonin (0-5): 5
Action on Dopamine (0-5): 0
Most Common Side Effects: impaired concentration, amnesia, apathy, depression, aggravated depression, suicide attempt, confusion, tachycardia, postural hypotension, paresthesia, migraine, saliva increased, flatulence, increased appetite, decreased weight, increased weight, amenorrhea, libido decreased, anorgasmia, impotence, coughing, rash, pruritus, accomodation abnormal, taste perversion, polyuriaLEXAPRO*
Dosage Range: 5-20 mg
Sedation: Low
Anticholinergia: None
Action on Norepinephrine (0-5): 0
Action on Serotonin (0-5): 5
Action on Dopamine (0-5): 0
Most Common Side Effects: dreaming abnormal, lethargy, irritability, concentration impaired, paresthesia, light-headed feeling, migraine, tremor, vertigo, vision blurred, ear ache, tinnitus, vomiting, flatulence, heartburn, tooth ache, gastroenteritis, abdominal cramp, gastroesophageal reflux, appetite increased, increased weight, decreased weight, urinary tract infection, urinary frequency, menstrual cramps, impotence, anorgasmia, decreased libido, bronchitis, sinus congestion, coughing, sinus headache, nasal congestion, rash, arthralgia, neck/shoulder pain, muscle cramp, myalgia, yawningULTRAM
Dosage Range: 100-400mg
Action on Opioid System (0-5): 2
Action on Norepinephrine: 1
Action on Serotonin: 1
Action on Dopamine: 1
Most Common Side Effects: dizziness, CNS stimulation, somnolence, confusion, euphoria, headache, nausea, constipation, flatulence, orthostatic hypotension, tachycardia, pruritus, rash, urinary rentention, urinary frequency, menopausal symptoms, dysuria, amenorrhea*often higher doses are required to control obsessive-compulsive symptoms than the doses generally used to treat depression.
Anticholinergic symptoms include dry mouth, constipation, urinary retention, blurred vision, memory impairment, and confusional states.
I got the info on sedation, anticholinergia, and neurotransmitter action for each of these drugs from this chart, which I find very useful:
http://64.33.4.253/assets/images/Medications%20Card%202002.pdf
The information on Ultram came from http://64.33.4.253/assets/images/Medications%20Card%202002.pdf, as well as some other sources I can't recall at the moment.
The side effects listed for Anafranil, Prozac, Zoloft, Paxil, and Ultram I got from "Mosby's Drug Guide for Nurses - Revised Reprint with 2004 Update". The side effects for Luvox, Celexa, and Lexapro came from the drug monographs at http://www.rxlist.com.
My personal experience with Anafranil was that it was way too similar to Luvox, but with a very unwelcome anticholinergic effect... in short, it was awful. But YMMV.
poster:Ame Sans Vie
thread:244947
URL: http://www.dr-bob.org/babble/20030723/msgs/245524.html