Clofranil (Clomipramine) vs. Other OCD Treatments: A Detailed Comparison

Key Takeaways

• Clofranil is a tricyclic antidepressant that works well for OCD but has a higher side‑effect burden than many newer drugs.
• SSRIs such as fluoxetine, sertraline and fluvoxamine are first‑line choices because they are effective, safer and easier to tolerate.
• If you can’t handle SSRI side effects, venlafaxine (an SNRI) offers a middle ground in efficacy and tolerability.
• Non‑drug options like cognitive‑behavioral therapy (CBT) can match medication for many patients, especially when combined with a lower dose of medication.
• Choosing the right treatment means balancing symptom relief, side‑effect profile, drug interactions, cost and personal preference.

If you’re wondering whether Clofranil is still the right pick for your OCD, you’re not alone. The drug has been around for decades, but newer options have entered the market, promising similar relief with fewer hassles. Below we break down what Clofranil does, how it stacks up against the most common alternatives, and what factors should guide your decision.

What Is Clofranil?

Clofranil is the brand name for clomipramine, a tricyclic antidepressant (TCA) that was first approved in the 1960s. It works by blocking the reuptake of serotonin and norepinephrine, increasing their levels in the brain. Because OCD symptoms are linked to serotonin dysregulation, Clofranil became a go‑to drug for this condition.

Typical dosing for adults starts at 25mg daily, slowly titrating up to 200mg depending on response and tolerability. The medication is taken once or twice a day, usually with food to lessen stomach upset.

Common side effects include dry mouth, constipation, drowsiness, weight gain, and sexual dysfunction. More serious concerns are heart rhythm changes and potential interactions with other serotonergic agents, which can trigger serotonin syndrome.

First‑Line Alternatives: SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are now the preferred first‑line drugs for OCD because they target the same neurotransmitter system with a cleaner safety profile.

Fluoxetine is an SSRI that blocks serotonin reuptake, raising serotonin levels in the synaptic cleft. It’s widely prescribed for depression, anxiety and OCD.

Sertraline is another SSRI renowned for its strong evidence base in OCD treatment. It’s often started at 50mg daily and can be increased to 200mg.

Fluvoxamine was actually developed for OCD rather than depression, making it a particularly targeted option. Doses typically range from 100‑300mg per day.

SSRIs share side effects such as nausea, insomnia, and mild sexual dysfunction, but they rarely cause the cardiac issues seen with TCAs.

Other Prescription Options

If SSRIs aren’t effective or tolerated, clinicians may turn to other classes.

Venlafaxine is an SNRI that inhibits the reuptake of both serotonin and norepinephrine. It offers comparable efficacy to SSRIs for OCD and can be useful when patients need a boost in norepinephrine activity.

Paroxetine is an SSRI with a longer half‑life, sometimes favored for patients who miss doses because it maintains steadier blood levels.

Escitalopram is a newer SSRI that tends to cause fewer sexual side effects, making it attractive for younger adults.

Non‑pharmacologic therapy remains a powerful tool. Cognitive‑behavioral therapy (CBT), especially exposure and response prevention (ERP), can achieve similar symptom reductions as medication, and many guidelines recommend combining CBT with a low‑dose drug for optimal results.

Side‑Effect Snapshot

Effectiveness for OCD

Clinical trials consistently show that all listed SSRIs achieve a 40‑60% response rate in moderate‑to‑severe OCD. Clofranil usually tops the efficacy chart, with response rates around 60‑70%, but the margin narrows when side‑effects cause discontinuation.

Venlafaxine sits in the middle, offering about a 50% response rate, while CBT alone can reach 50‑60% when delivered by an experienced therapist. Combining CBT with a lower dose of any medication often pushes response rates above 70%.

Cost Considerations (2025 US & Australian Prices)

• Clofranil: Generic clomipramine - approxAU$0.30 per 25mg tablet (≈AU$90/month at 200mg).
• Fluoxetine: Generic - AU$0.15 per 20mg capsule (≈AU$45/month at 60mg).
• Sertraline: Generic - AU$0.20 per 50mg tablet (≈AU$60/month at 200mg).
• Fluvoxamine: Generic - AU$0.25 per 100mg tablet (≈AU$75/month at 300mg).
• Venlafaxine: Generic - AU$0.22 per 75mg tablet (≈AU$66/month at 300mg).
• CBT: Average 12‑session course - AU$1,200‑$1,800 (often covered by private health insurance).

How to Choose the Right Option

1. Symptom severity: For severe, treatment‑resistant OCD, starting with Clofranil may give the strongest initial push.
2. Side‑effect tolerance: If dry mouth, constipation, or cardiac concerns are a deal‑breaker, an SSRI or venlafaxine is safer.
3. Drug interactions: Patients on other serotonergic meds, certain antibiotics, or anti‑arrhythmics should avoid TCAs.
4. Cost & insurance: Generic SSRIs are often cheaper and more accessible through national health schemes.
5. Patient preference: Some people prefer a medication‑free route and will opt for CBT first.

Discuss these points with your prescriber. A trial period of 8‑12 weeks at a therapeutic dose is typical before evaluating response.

Quick Decision Tree

• Do you have a history of heart disease? → Yes: Skip Clofranil, choose SSRI or venlafaxine.
• Are you able to attend regular psychotherapy? → Yes: Consider CBT alone or combined with low‑dose SSRI.
• Do you need the fastest possible symptom drop? → Clofranil may act quicker but watch for side effects.
• Is cost a major factor? → Generic fluoxetine or sertraline are the cheapest options.