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  1. #1
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    Imipramine or Clomipramine

    My doctor wants me to try imipramine, but everything I read points to clomipramine being superior. I suffer mainly from extreme anxiety (psych thinks I have anxious depression) and some depression. Not really any OCD, although when my anxiety is high, I have OCD thoughts. I don't want to start imipramine, only to wish I started clomipramine. The side effects of imipramine seem to be worse than clomipramine. Any help would be appreciated (hopefully you could help me PDU)? Other meds include Mirt 30mg, Olanzapine 2.5mg and Nortriptyline 125mg. I would be changing from Nortriptyline as I am still getting anxiety and depression while on it. TIA.
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    Re: Imipramine or Clomipramine

    Quote Originally Posted by Mermaid16 View Post
    I don't want to start imipramine, only to wish I started clomipramine. The side effects of imipramine seem to be worse than clomipramine.
    Clomipramine is the most potent non MAOI antidepressant available. It is a pity it became so strongly linked to OCD that many doctors now think this is all it's good for. It works just as well for the other anxiety disorders and depression and is about as effective for treatment-resistant (refractory) depression as the MAOIs.

    BTW-clomipramine is a more potent 5-HT2a receptor antagonist than mirtazapine, which supposedly is responsible for the mirtazapine therapeutic response (it almost certainly isn't), so there would seem to be no point in continuing to take it if you're on clomipramine except perhaps as a antihistamine sedative, but this was even more the case with nortriptyline too.

    The typical TCA anticholinergic side-effects such as dry-mouth and constipation may be a little more severe than with imipramine, but about the same as with nortriptyline.

  3. #3
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    Re: Imipramine or Clomipramine

    Thanks for your response once again PDU. You're awesome. I have read a few studies where they have compared the two. One of them states: 'With respect to all major outcome parameters ie full panic attacks, total number of anxiety attacks (full plus mild), and anxiety between attacks, the effect of clomipramine was clearly and significantly superior to that of imipramine'. I will need to discuss with psych further and will take the study with me.
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    Re: Imipramine or Clomipramine

    Quote Originally Posted by Mermaid16 View Post
    I have read a few studies where they have compared the two. One of them states: 'With respect to all major outcome parameters ie full panic attacks, total number of anxiety attacks (full plus mild), and anxiety between attacks, the effect of clomipramine was clearly and significantly superior to that of imipramine'. I will need to discuss with psych further and will take the study with me.
    If panic attacks were your main problem I'd be suggesting imipramine as it was the 'gold standard' med for panic disorder until the SSRIs became available and worked well for me. But for mixed anxiety and depression clomipramine is likely to be the better bet.

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    Re: Imipramine or Clomipramine

    Mermaid, I have an agitated depression diagnosis and it's a very complex condition to treat. I remember that my psych from many years back (now a published author and renowned in the psych world) put me on moclobemide but this drug is probably not used much now.

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    Re: Imipramine or Clomipramine

    Thanks PDU and Pulisa. I think it is a combination of anxiety and depression. I think the clomipramine would be better. I guess I will speak to the psych and see what she recommends with all the information I have gathered. I just don't want to push for the clomipramine and for it to come back and bite me on the bum. I just hope I can get through any added anxiety and depression I might experience when I am swapping over.
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    Re: Imipramine or Clomipramine

    Hi PDU, I was wondering if you could tell me what the difference (if any) is between, Nortriptyline, Imipramine and Clomipramine. Also when swapping over, is there likely to be a lot of side effects, given they are from the same class of meds. Also if Nortriptyline didn't work, is it likely that swapping to Imipramine won't do much good either? My main complaints are high anxiety and depression. Thanks PDU.x
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    Re: Imipramine or Clomipramine

    Quote Originally Posted by Mermaid16 View Post
    what the difference (if any) is between, Nortriptyline, Imipramine and Clomipramine.
    Nortriptyline is a straight noradrenaline/norepinephrine reuptake inhibitor. It has little impact on serotonin. Imipramine is a fairly potent serotonin and mild noradrenaline reuptake inhibitor, and clomipramine is both a very potent serotonin and noradrenaline reuptake inhibitor.

    Also when swapping over, is there likely to be a lot of side effects, given they are from the same class of meds.
    Perhaps as you're going from a med with very little serotonin activity to a very potent serotonin reuptake inhibitor. However, the TCAs tend to produce less severe side-effects at the beginning than SSRIs/SNRIs, although, as with everything about antidepressants, there are no guarantees.

    TCAs are not a uniform group of meds which all do basically the same thing as is the case with SSRIs. Their effects differ greatly in how they work.

    Also if Nortriptyline didn't work, is it likely that swapping to Imipramine won't do much good either? My main complaints are high anxiety and depression.
    Not necessarily as they do different things.

  9. #9
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    Re: Imipramine or Clomipramine

    Thanks again Ian for your invaluable information. I am seeing the psych tomorrow and will discuss the Imipramine and Clomipramine with her...I am pretty sure she will stick to her guns though. I have asked about the clomipramine twice before, the first time she said it was for OCD and the second time she said it is too sedating.
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    Re: Imipramine or Clomipramine

    Quote Originally Posted by Mermaid16 View Post
    the first time she said it was for OCD and the second time she said it is too sedating.
    Wrong on both counts. Sedation is mostly produced by antihistamine potency and clomipramine is a weaker histamine H1 antagonist than nortriptyline, though imipramine is a little weaker again. a1-andrenergic and 5-HT2a receptor antagonism also plays a part and in that regard again there isn't that much difference between clomipramine and nortriptyline, so if sedation wasn't an issue with nortriptyline then it shouldn't be with clomipramine.

    Anyway, if she is so concerned about sedation why are you on mirtazapine and olanzapine which are both very sedating?

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