View Full Version : Clomipramine / Anafranil worked GREAT but only for a few scattered days...WHY?!!


sbcy
12-12-12, 03:49 AM
I started at 25mg/day clomipramine and my doctor and I slowly titrated up by about 25mg each weeks. When ever I upped the dosage, within a day or two, I typically noticed I significant improvement in my ability to pay attention, vastly increased cognitive flexibility and a much better ability to understand and empathize with other people. The next day, this positive blast of flexibility and focus, was basically gone and my tics were back. The side effects were nothing unbearable so we continued titrating up. This same brief positive experience happened again when I upped the dosage a few more times. I have never felt more clear minded than I have these few days clomipramine did something positive for my focus and OCD. But for the most part, even when I got up to 250mg, it hasn't been helping with my focus, anxiety and empathy anything near what it was in between dosage bumps up. I've since come down to 75mg and may end up stopping Clomipramine because of the lack of consistent success.
What do you think happened here? Can anyone please offer their insight? I'm really baffled as I've been pursuing treatment for my life long symptoms for nearly a decade now with almost no success. If there was a way to consistently re-kindle that state of mind that I was in, I would basically call myself "cured".

Please note: This state of mind I was in, was by no means a "high"....I've experienced the rush and mood lift of taking too much Adderall and other stimulants (inadvertently) and my experiences on Clomipramine were NOT anything like that.

Perseverations
12-27-12, 04:40 AM
Sounds to me like you most likely are getting a boost from clomipramine, but when your body metabolizes into a more steady-state solution of clomipramine and desmethylclomipramine, you end up having the negative effects (esp. anxiety) from desmethylclomipramine, which is a strong NRI.

Balance between the two is usually maintained/controlled by concurrent administratoin of a CYP1A2 or CYP2D6 inhibitor. Fluvoxamine is the gold standard. When I was on Fluvoxamine and Clomipramine, constipation aside, it was the best set of medications I'd ever had.

(This was prescribed at 300mg Luvox 150mg Clomipramine QHS PO for GAD, OCD, MDD, and ED-NOS.)

Of course, it was titrated up - 50mg, then 75, then 100, then 150. I really needed that extra synergy myself. It has been a long time since I have taken this medication, but I do recall that it was the only one which I can clearly remember making me clearly notice I could feel a different sense of hope.

I recommend that you talk to your doctor and mention this as a possibility. Not Luvox per se, but anything to balance it more towards serotonergic and less NET inhibitory mechanisms.

Best wishes,

Dan