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Hello everyone

I am new here and have had OCD for about 30 years although it only began severely impacting my life 10 years ago.

After unsuccessful attempts with several SSRI’s, I have now been prescribed clomipramine. As my GP was waiting for the dosage advice from my consultant, I was only prescribed 10mg to start with which I started last week.

Over this weekend, my OCD symptoms seem to be worsening with increased anxiety and obsessive thoughts and I am at my wits end.

I appreciate that the low dose and short time I have been taking it means that it is unlikely to be the clomipramine, but I just wondered if anybody else had experienced a spike in their symptoms after starting a new medication and if it settled down?

Thank you all.

Edited by Gingham
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I have been on clomipramine for about 6 months now and I am finding it helpful in helping me be able to challenge the thoughts. I was started on 100mg by my psychiatrist and was told the dosage needed for OCD was 200-250mg (250mg is the max dose) Of course I am not trying to spread wrong information or anything, I’m just saying what I was told. I am now on 250mg.

I have definitely noticed a spike in OCD after I started and after each increase! It normally happens for me around a week after the increase where it spikes the most. For me it was also physical which I’m happy to share with you but I won’t right now unless you want to know (nothing bad). I was also told clomipramine takes longer to get into your system than some other SSRI’s as it’s an older drug so to give it extra time to get used to get used to it. 
 

I have also tried numerous medications from SSRI’s to an anti psychotic and clomipramine has definitely helped me the most so I really hope things settle down for you! :) 

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Thank you for replying - I am aware I am on a very low dose so it is helpful to know that a spike in symptoms initially is not an indication that it won’t work in the end and at least I can be prepared for a potential uptick in symptoms with each increase.

So far I have not experienced any physical side effects although, at this stage, I am prepared to put up with almost anything if it means I can manage the OCD better! I assume you have been able to manage the physical side effects (feel free to share these if you are happy to do so!)? Did you find these also eased as your body adjusted to the new doses?

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3 minutes ago, Gingham said:

Thank you for replying - I am aware I am on a very low dose so it is helpful to know that a spike in symptoms initially is not an indication that it won’t work in the end and at least I can be prepared for a potential uptick in symptoms with each increase.

So far I have not experienced any physical side effects although, at this stage, I am prepared to put up with almost anything if it means I can manage the OCD better! I assume you have been able to manage the physical side effects (feel free to share these if you are happy to do so!)? Did you find these also eased as your body adjusted to the new doses?

Yes definitely the spike does not mean it’s not going to work, I thought the same though! I think because I was told this would be like ‘the golden ticket’ medication for ocd I didn’t prepare myself that it takes time to get to that point. 
 

The physical side effects I have from the medication is a very dry mouth, but I manage that by chewing sugar free gum, mints, or just having sips of drink. The dry mouth has probably got worse the higher the dose but I’m used to it now and if anything it does help me drink more water which I was terrible at before 😂 I had bad heartburn that wasn’t fixed by Rennies etc but I was given a prescription heartburn medicine to take in the mornings which has solved that issue so it’s not a problem anymore! And I also find I sweat more and even when I’m freezing cold! 😂  that one’s taken some getting used to but my psychiatrist did say there is medication if it gets unbearable so there is help for that if needed. Given the heatwave I feel like I blend in alright right now so I’m not worried 😂 

also my psychiatrist says that these side effects may still ease up the more my body gets used to them, and if not they definitely aren’t unbearable or can’t be managed :) 

 

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Thank you so much - it is good to hear there are options for dealing with some of the side effects. I know everyone is different, but it is helpful to hear someone else’s experience…interestingly the last couple of nights I have had bad heartburn and assumed it was just down to feeling all at ‘sixes and sevens’ with the heat but I will keep an eye on it as it sounds as though it could be a side effect…🤔

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13 minutes ago, Gingham said:

Thank you so much - it is good to hear there are options for dealing with some of the side effects. I know everyone is different, but it is helpful to hear someone else’s experience…interestingly the last couple of nights I have had bad heartburn and assumed it was just down to feeling all at ‘sixes and sevens’ with the heat but I will keep an eye on it as it sounds as though it could be a side effect…🤔

You’re welcome, you’re definitely not alone.

ah yes! I was told I can only get my clomipramine in 50mg tablets so I need to take 5 to get the dose I’m prescribed so don’t think that helps either. 

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Thanks for checking in @OB1UK…I am still having an overwhelming general anxiety in the mornings mainly, which I have not had before - normally my anxiety is focussed on my rituals.

I am going to be increasing the dose over the next couple of weeks so I will have to try to get through as best as I can to give them time to work…hopefully when I am at the right dose for me things will settle down a bit.

The other side effects aren’t too bad at the moment (although I take it at night but then can’t sleep and end up dozing off the following afternoon…!).

Thanks @Handy too - I will keep going with them for a few months to see if there is any positive effect for me. I am also doing ERP alongside the tablets so I am hoping that doing both together will bring some improvement  🤞

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10 hours ago, Gingham said:

Thanks for checking in @OB1UK…I am still having an overwhelming general anxiety in the mornings mainly, which I have not had before - normally my anxiety is focussed on my rituals.

I am going to be increasing the dose over the next couple of weeks so I will have to try to get through as best as I can to give them time to work…hopefully when I am at the right dose for me things will settle down a bit.

The other side effects aren’t too bad at the moment (although I take it at night but then can’t sleep and end up dozing off the following afternoon…!).

Thanks @Handy  🤞

General Anxiety in AM is hormonal.  Everyone I asked gets it at some time.  Cortisol, our stress hormone is highest when we get up & serotonin is depleted.  So one obsesses about stress.  If drinking alcohol night before it'll deplete serotonin even more. 

Solution is get up & exercise to reverse these hormones.  Does it work? Yes, it does. 

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I used to have a job where I could cycle to work. I was always anxious before getting on the bike, but by the time I got there I would feel much better. Overall I felt much calmer during the day 

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Hi @foreverobsessing

I am doing ok I think…am up to 25mg now and going to 50mg tomorrow and 75mg a few days after that - then it will go to 100mg. So far the side effects have been ok…I had a few days of hot flushing and sweating but that seems to have settled down (although I anticipate it will return with the increase in dose). I have still got the ongoing general anxiety although, as Handy says above, it does ease slightly once I am up and about.

I am curious about how it might feel if/when I start to feel the benefits of the medication. I appreciate I will still have the urges to be tapping and checking and doing things ‘just right’ but I can’t imagine being able to not perform a ritual and then have that anxiety pass and forget about it.
 

Sometimes now, there is a part of me that seems to feel ‘I don’t need to be doing this’ (a bit like I used to feel 10/20 years ago when OCD was a mere inconvenience rather than a life destroying nightmare) but I still can’t bring myself to walk away as I think ‘what if in 6 weeks/months/years, the anxiety does not pass and I cannot go back and ‘fix’ what I have done ‘wrong’’. I don’t know whether there is a bit of a placebo effect going on with the clomipramine as I can’t imagine it would be doing anything yet…but I just want OCD gone enough to let me function again.

My therapist is off for the next few weeks so I am going to have to try to keep pushing myself to try more exposure exercises which I guess is a good way to tell if the meds are helping!

Are you getting on ok? 
 

Thank you for checking in with me - it helps knowing I am not alone!

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2 hours ago, Gingham said:

Hi @foreverobsessing

I am doing ok I think…am up to 25mg now and going to 50mg tomorrow and 75mg a few days after that - then it will go to 100mg. So far the side effects have been ok…I had a few days of hot flushing and sweating but that seems to have settled down (although I anticipate it will return with the increase in dose). 

If you take too much you risk getting Serotonin Syndrome & you don't want that.

Anxiety is necessary for survival.  It protects us.  

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On 19/08/2022 at 22:59, OB1UK said:

I used to have a job where I could cycle to work. I was always anxious before getting on the bike, but by the time I got there I would feel much better. Overall I felt much calmer during the day 

Yes biking brings in the good stuff that counters cortisol. I'll do 20 miles bike, 4 miles walk & a swim a few times a year. Exercise is a good coping mechanisms for self soothing.

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4 minutes ago, Handy said:

If you take too much you risk getting Serotonin Syndrome & you don't want that.

Anxiety is necessary for survival.  It protects us.  

Handy, clomipramine is not an SSRI. It doesn't work via serotonin.  :wontlisten:

Please be careful what you post as sometimes it is inaccurate.

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16 hours ago, snowbear said:

Handy, clomipramine is not an SSRI. It doesn't work via serotonin.  :wontlisten:

Please be careful what you post as sometimes it is inaccurate.

Yes it does! Clomipramine is a tricyclic antidepressant but it still “works via Serotinin”. 

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On 14/08/2022 at 18:18, Gingham said:

Hello everyone

I am new here and have had OCD for about 30 years although it only began severely impacting my life 10 years ago.

After unsuccessful attempts with several SSRI’s, I have now been prescribed clomipramine. As my GP was waiting for the dosage advice from my consultant, I was only prescribed 10mg to start with which I started last week.

Over this weekend, my OCD symptoms seem to be worsening with increased anxiety and obsessive thoughts and I am at my wits end.

I appreciate that the low dose and short time I have been taking it means that it is unlikely to be the clomipramine, but I just wondered if anybody else had experienced a spike in their symptoms after starting a new medication and if it settled down?

Thank you all.

hi,

i’ve known i’ve had ocd for about 13 years, i’ve never done anything about it nor told anyone. but recently i’ve had the urge to want to get help as it really impacts me. 

i just wanted to know, how does the medication work for you? for me, my ocd is based around particular things i’m scared about that could happen like dying or being sick, so i rid these thought by doing repeating phrases in my head until i believe in myself that this thing is now not going to happen. as well as other rituals that we won’t get into. 

but obviously doing these rituals and saying these phrases gives me some comfort for a couple of seconds. until i get distracted by doing something physical. then the cycle repeats when it pops back into my head. how do you think the medication effects these thoughts? right now i feel as if i will never not do it with even a miracle, let alone medication.

any help would be so enlightening.

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26 minutes ago, pbb said:

i just wanted to know, how does the medication work for you?

Anti-depressent medication for me was used to lift my mood (how this is done in terms of chemistry it appears that even the Medics dont know exactly how, but they do agree it works).

With regards to my OCD treatment I have had various therapies (the most recent being Cognitive Behavioural Therapy).

For me starting on an antidepressant for up to 3 months prior to starting CBT did indeed lift my mood a bit and made me more receptive to CBT.

Medication alone would be unlikely to 'cure' my OCD but a significant lift in the mood has in the past reduced my OCD.

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On 22/08/2022 at 18:00, snowbear said:

Handy, clomipramine is not an SSRI. It doesn't work via serotonin.  :wontlisten:

Please be careful what you post as sometimes it is inaccurate.

Huh? 

"

Drugs that should not be used with clomipramine

You should not take certain drugs with clomipramine. When used with clomipramine, these drugs can cause dangerous effects in the body. Examples of these drugs include:

Monoamine oxidase inhibitors such as selegiline, and drugs such as linezolid, methylene blue, fentanyl, tramadol, lithium, buspirone, and St. John’s wort. When used with clomipramine, these drugs can increase your risk of developing serotonin syndrome. This can lead to nausea, vomiting, diarrhea, agitation, delirium, coma, muscle rigidity, tremor, seizures and sometimes death. You should not use clomipramine and these drugs within 14 days of each other."

 

"Clomipramine increases the levels of serotonin in the brain. Co-administration with other medications that also increase serotonin levels increases the risk of serotonin syndrome. Symptoms of serotonin syndrome include rapid development of hyperthermia (high body temperature), high blood pressure, muscle rigidity, confusion, and delirium. Some medications that increase serotonin levels are monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and linezolid (Zyvox). For a complete"

 

 

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4 hours ago, Handy said:

Huh? 

"

Drugs that should not be used with clomipramine

You should not take certain drugs with clomipramine. When used with clomipramine, these drugs can cause dangerous effects in the body. Examples of these drugs include:

Monoamine oxidase inhibitors such as selegiline, and drugs such as linezolid, methylene blue, fentanyl, tramadol, lithium, buspirone, and St. John’s wort. When used with clomipramine, these drugs can increase your risk of developing serotonin syndrome. This can lead to nausea, vomiting, diarrhea, agitation, delirium, coma, muscle rigidity, tremor, seizures and sometimes death. You should not use clomipramine and these drugs within 14 days of each other."

 

"Clomipramine increases the levels of serotonin in the brain. Co-administration with other medications that also increase serotonin levels increases the risk of serotonin syndrome. Symptoms of serotonin syndrome include rapid development of hyperthermia (high body temperature), high blood pressure, muscle rigidity, confusion, and delirium. Some medications that increase serotonin levels are monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, and linezolid (Zyvox). For a complete"

 

 

👍

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  • 1 month later...

Hello @OB1UK

Thank you for asking, I am getting on ok and have been taking 150mg for the last 10 days.

I did think it was starting to help but that might have been a bit of a placebo effect as I’ve not been on it long enough really and the last week or so, I have felt the anxiety creeping back in and the thoughts getting stronger (although I am hoping that has happened as a result of the last increase from 100mg to 150mg).

My GP surgery has said my consultant wants me to stay on the 150mg whereas I thought it needed to be a bit higher for OCD, but I will give it a few more weeks and then see how I feel. 

Side effect wise, I have been ok - I still have hot flushes sometimes (but as someone who is always cold and with winter approaching, this isn’t too bothersome!) and I am able to sleep better at night which has been welcomed. 

I am working with a therapist too and have managed to eliminate some of my rituals which is a massive step (although the ones I have stopped were the lowest on my hierarchy so I am trying to work out how best to tackle the more entrenched ones next…).

Overall I just feel a bit despairing at the moment - wondering how I am ever going to be able to be at the point when OCD doesn’t dominate my entire life. I know it will be slow and steady and that it isn’t going to disappear completely but I am so frustrated and exhausted by the constant fear, anxiety and dread and everything being so much more complicated just because of OCD and the rituals.

I am relieved that I seem to be tolerating the clomipramine better than the SSRIs I tried in the past and I am still hoping I will get more benefit the longer I am on them 🤞

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Thanks for the update. I’m glad you’re at least tolerating the meds and things are sort of moving in the right direction. I’ve been back on citalopram now for 11 weeks and it’s been a pretty rough ride. I still don’t really feel much benefit. I’m going to request a dose increase soon

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