Key points
- The FDA label covers one use: obsessions and compulsions in obsessive-compulsive disorder (OCD).
- Anxiety is not an approved use, and this page does not describe it as an off-label anxiety treatment.
- The boxed warning covers suicidal thoughts and behavior in children, teens and young adults.
- The label names seizure as the most significant risk seen before approval.
- It must not be used with MAOIs or within 14 days of one.
What clomipramine is
Clomipramine is a capsule in the tricyclic group of antidepressants, sold as Anafranil and as a generic. Though it belongs to an antidepressant group, its label is about OCD rather than depression.
NIMH describes OCD as a disorder marked by uncontrollable, recurring thoughts (obsessions), repetitive and excessive behaviors (compulsions), or both. Living with OCD can take up a lot of time and energy. NIMH notes that treatments can help people manage their symptoms and take part in daily life.
What it is approved for, and what it is not
The FDA label says clomipramine is for treating obsessions and compulsions in people with OCD, when they cause marked distress, take up a lot of time or interfere with work or social life. The studies behind that use included adults, and children and teens ages 10 to 17. MedlinePlus also describes it as a treatment for people with OCD.
It is not FDA-approved for anxiety, and this page does not describe it as an off-label anxiety treatment. NIMH says it is common for people with OCD to also have a mood or anxiety disorder, and our online anxiety treatment page describes online care for anxiety. The label also says it is not approved for bipolar depression, and that safety and effectiveness in children have not been established except in OCD.
How it is thought to work
The label says clomipramine is presumed to affect obsessive and compulsive behaviors through serotonin signaling. The exact mechanism is unknown, but its ability to block the re-uptake of serotonin is thought to be important. MedlinePlus says similarly that it increases the amount of serotonin in the brain.
What taking it can be like
MedlinePlus says it may take several weeks or longer to feel the full benefit, and that a prescriber may raise the amount slowly. Change with OCD can be gradual. Small shifts, such as less time spent on a ritual, are worth writing down and sharing.
Do not stop clomipramine without talking to your prescriber. The label reports dizziness, nausea, vomiting, headache, malaise, sleep problems, high body temperature and irritability after stopping abruptly, and says people may also feel psychiatrically worse. MedlinePlus says your doctor will probably lower the amount gradually.
MedlinePlus says it may make you drowsy and that alcohol can add to the drowsiness. Be careful with driving and other risky tasks until you know how it affects you.
Side effects and warnings
Boxed warning: in short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, teens and young adults. There was no such increase in adults over 24, and adults 65 and older had a lower risk. Everyone taking it should be observed for worsening symptoms or unusual behavior, especially early on. If you have thoughts of suicide or are in crisis, call or text 988, or call 911. Locascio Wellness does not provide emergency services. Our crisis resources page can help too.
The label names dry mouth, constipation, nausea, indigestion, loss of appetite, drowsiness, shaking, dizziness, nervousness, muscle jerks, changes in sex drive, ejaculation problems, erection problems, tiredness, sweating, increased appetite, weight gain and vision changes as the most commonly observed effects. It says sexual problems were markedly more common in men on clomipramine than on placebo. These can be hard to bring up, and your prescriber will want to know.
- Seizures: the label calls this the most significant risk identified before approval. Tell your prescriber about any history of seizures, brain injury or heavy alcohol use.
- MAOIs: use with an MAOI, or within 14 days of one, is contraindicated because of serotonin syndrome risk. This includes beginning it during linezolid or intravenous methylene blue.
- Heart attack: contraindicated during the acute recovery period. Allergy to it or another tricyclic is also a contraindication.
- Eyes: pupil widening may trigger angle-closure glaucoma in people with narrow eye angles.
- Older adults: MedlinePlus says they should not usually take it, so talk through risks and benefits.
- Tell your prescriber if you are pregnant, planning a pregnancy or breastfeeding.
Can it be managed online in Pennsylvania and New York
Clomipramine capsules are taken at home, and the label does not limit them to a certified healthcare setting. Video visits can cover symptoms, side effects, and your seizure and heart history. A video visit cannot run tests such as a heart tracing, so ask how those would be arranged if you need them.
A licensed psychiatrist on our team, a Doctor of Osteopathic Medicine (DO) with more than three decades of practice, treats anxiety, depression and trauma online by secure video, for people physically located in Pennsylvania or New York during each visit. Our medication management page has more. Therapists on our team do not prescribe.
Whether it is an option for you is a decision for you and your prescriber. Ask us whether our psychiatrist can help with OCD, using our medication contact form.
Common questions
Is clomipramine used for anxiety?
It is not FDA-approved for anxiety. The label covers obsessions and compulsions in OCD, and MedlinePlus describes the same use. This page does not describe it as an off-label anxiety treatment. If anxiety is your main concern, a prescriber can talk through the options that fit you.
What should I know about clomipramine and seizures?
The label names seizure as the most significant risk identified before approval, and says dose appears to be one predictor. It urges caution for people with a history of seizures or other things that raise the risk. Tell your prescriber about your history, and call 911 if a seizure happens. Do not change how you take it on your own.
Can teens take clomipramine?
The label says safety and effectiveness in children have not been established except in OCD, and its OCD studies included ages 10 to 17. The boxed warning about suicidal thoughts applies to young people. Parents should talk through risks with their child's doctor. We cannot say here which ages our psychiatrist sees, so please ask us.
Sources
Published by Locascio Wellness. Published November 5, 2026. Clinically reviewed by Kenneth M. Levy, DO, Psychiatrist (Pennsylvania license OS007464L). This page is general information, not medical advice or a diagnosis.