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16 min read

Anafranil for OCD: uses, effectiveness, and side effects

Written by Dr. Geralyn Dexter

Published: Apr 9, 2024

Medically Reviewed by Goldina Erowele, PharmD, MBA

Table of contents

For decades, providers have prescribed Anafranil for OCD (obsessive-compulsive disorder) to reduce the OCD symptoms of intrusive thoughts and compulsive behaviors. This antidepressant, though slightly different from well-known medications like Zoloft and Lexapro, is shown to be superior for OCD treatment when used on its own or in combination with other approaches. 

Keep reading to learn more about Anafranil for OCD, how it works, what the science says, its side effects, and its effectiveness when combined with other treatment options. 

What is Anafranil (clomipramine)?

Anafranil (clomipramine) is a medication used to treat OCD in people 10 and older. It’s an antidepressant and was U.S. Food and Drug Administration (FDA)-approved to treat OCD in 1991. It was the first medication shown to benefit people with OCD

While it’s approved to treat OCD, Anafranil is also used off-label to help manage other disorders, including:

How does Anafranil work for OCD?

OCD is a condition characterized by intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) done to relieve the distress and anxiety caused by the thoughts. Symptoms of OCD can be debilitating and take over your life. You might find yourself struggling to function at home, work, school, or in your relationships. Anafranil is one medication option to help manage OCD symptoms. 

Anafranil belongs to a medication class called tricyclic antidepressants (TCAs). Antidepressants work by influencing the levels of neurotransmitters in your brain. Anafranil is a TCA that works on serotonin and norepinephrine, 2 brain chemicals that regulate mood. It’s been shown to be a powerful agent in the reuptake of serotonin. 

Anafranil effectiveness: does Anafranil work for OCD?

Research and anecdotal reports shows that Anafranil is a great option for managing OCD. While the medication may not work for everyone, many people benefit from managing their OCD with medication. 

What the science says about Anafranil’s effectiveness for OCD

Research shows that Anafranil is an effective option for OCD treatment. A meta-analysis published in The British Journal of Psychiatry: The Journal of Mental Science, looked at double-blind clinical trials and found that Anafranil was better than a placebo at reducing obsessions and compulsions when considered together. The review also showed that Anafranil was effective at reducing obsessive and compulsive symptoms individually. 

While effective on its own, a paper published in Current Neuropharmacology found that combining Anafranil and evidence-based therapies like Exposure and Response Prevention (ERP) may provide the best outcomes for people with OCD. 

What people using Anafranil for OCD say

Now that you know a little bit about the research, you might wonder about the experiences of people who actually use Anafranil. Reviews of Anafranil on show that people are generally happy with the medication. 

At the time of publication, people taking Anafranil for OCD give it a rating of 7.9 out of 10 on, with 78% sharing a positive experience. Reviewers wrote about having minimal side effects when starting the medication and having a decrease in intrusive thoughts. 

One reviewer on wrote, “The best medication so far for OCD is Anafranil. It’s completely cured my OCD. Remember OCD is just a medical problem due to unbalanced chemicals in you[r] brain. It’s not you, it’s your brain sending you false messages. Don’t believe the obsessive thoughts, they may feel real but they are fake!”

And Living reported on, “I have been taking Anafranil 100 mg for a year now and it has changed my life. I have battled with OCD, severe anxiety, panic disorders, and intrusive thoughts since I was young. While trying different drugs finally at the age of 40, one drug works for me and this is it. I still have the ‘thoughts’ but instead of obsessing over them they pass by like moving cars. The side effects are bothersome dealing with constipation, bloating, sweating, insomnia, twitches. I don’t believe I can ever function without this medication and instead maybe lower my dosage to see if it reduces the side effects.”

Taking Anafranil for OCD: what you need to know

Beginning a new medication can be scary. You might have questions about what to expect and how long it will be before you start to feel better. These are valid questions. Keep reading to learn more about Anafranil doses for OCD, side effects, and more. 

Anafranil dosage for OCD

Anafranil is taken by mouth and comes in capsule form in dosages of 25, 50, and 75 milligrams. 

The initial Anafranil dosage for OCD is 25 milligrams. As you start Anafranil and throughout treatment, your provider will monitor you closely to see how you adjust to the medication. If you tolerate the drug with minimal side effects, your provider may gradually increase your dosage of Anafranil to 100 milligrams within your first 14 days.

If you continue tolerating the medication, your healthcare provider may increase your dosage over several weeks, checking your progress before making adjustments. The maximum dosage of Anafranil is 250 milligrams a day. 

Not everyone responds to oral Anafranil. In cases where people have OCD that’s resistant to treatment with antidepressants, research shows that intravenous Anafranil may be an option. 

How to take Anafranil for OCD

Your provider will give you instructions on how to take Anafranil for OCD. For the best results, they’ll ask that you take the medication at the same time every day. Depending on how you respond to the medication, this may be in the evening, especially if it makes you drowsy. 

Anafranil may cause stomach issues in some people. If that’s the case, your provider may recommend taking it with food to minimize gastrointestinal upset. 

Your provider will emphasize the importance of taking your medication consistently, every day at the same time. If you miss a dose, take your medication as soon as possible and continue with your regular schedule. Never take a double dose to make up for a missed dose. You can always reach out to your provider if you have questions about how to get back on track with your doses. 

How long will it take to work?

For the treatment of OCD, you may not start noticing changes for 6 to 12 weeks after starting Anafranil. This can feel like a long time to go without feeling relief. But your brain needs time to start improving the balance of its neurotransmitters, so it can take a while before you start feeling better on antidepressants. To give your brain the best chance to benefit, take your medication consistently and as prescribed by your provider. 

Your provider will have you schedule follow-up appointments to monitor your status and make any changes needed. Use your appointments as a time to talk about what’s working and what’s not. 

They can help to keep track of your symptoms and any changes. Sharing this information with your provider helps you work together to find the right dose for you. 

How to store Anafranil

If your provider prescribes Anafranil for OCD, you want to make sure it’s stored safely and securely. 

  • Keep the medication in its original container. 
  • Store it at room temperature. 
  • Avoid keeping your medication in a spot where there is moisture or excess heat.
  • Make sure you store it out of sight and reach of children and pets. 

Side effects of Anafranil for OCD

Before starting Anafranil, you want to talk with your provider to learn more about potential side effects. Once you start a medication, be patient with your body. It can take up to several weeks to adjust. 

Common side effects

When starting a new medication or adjusting the dose of a current one, you may experience side effects. Knowing the possible side effects and what to look for and checking in with your body can help you update your provider on your progress and make an informed decision about whether Anafranil for OCD is a good option for you. 

Common side effects of Anafranil include:

  • Dry mouth
  • Constipation
  • Nausea
  • Dyspepsia
  • Anorexia
  • Somnolence (drowsiness)
  • Tremor
  • Dizziness
  • Nervousness
  • Changes in libido
  • Ejaculation issues
  • Impotence (erectile dysfunction)
  • Fatigue
  • Sweating
  • Increased appetite
  • Weight gain
  • Visual changes

Serious side effects and warnings

In some cases, Anafranil can lead to serious side effects, including:

  • Seizures
  • Difficulty breathing 
  • Fast or irregular heartbeat
  • Delusions or believing things that aren’t true 
  • Hallucinations or seeing or hearing things that don’t exist
  • Unusual tiredness
  • Uncontrollable shaking
  • Angle-Closure Glaucoma (an acute condition that causes bulging of the iris and increased pressure in the eye)
  • Drug rash with eosinophilia and systemic symptoms (DRESS), a rare but serious rash that can occur when taking Anafranil 

Anafranil comes with a FDA boxed warning. Like other antidepressants, Anafranil can cause depressive symptoms to worsen or lead to suicidal thoughts and behaviors. If you start having suicidal thoughts while taking Anafranil, seek crisis support immediately, such as texting or calling the National Suicide Prevention Lifeline at 988, or reach out to your provider as soon as possible. 

If you experience serious side effects, your provider may instruct you to call them as soon as possible or seek immediate help in the case of a medical emergency. 

Drug interactions and contraindications on Anafranil for OCD

If you take other medications or have specific health concerns, share them with your provider before starting Anafranil. Giving your provider the full scope of your health status can help you make medication choices that reduce the chances of Anafranil worsening symptoms or interacting with other medications

Talk to your provider if you’ve experienced an allergic reaction or sensitivity to Anafranil or other TCAs, such as amitriptyline (Elavil) or nortriptyline (Pamelor). 

If you’ve taken a monoamine oxidase inhibitor (MAOI), such as isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Emsam), or tranylcypromine (Parnate), within 14 days, let your provider know. Using Anafranil within 2 weeks of an MAOI can lead to an increase in serotonin and potentially serotonin syndrome. Serotonin syndrome can also occur in people receiving treatment with linezolid or intravenous methylene blue.

If you’re pregnant or think you might be pregnant, tell your provider. Because Anafranil crosses the placenta, it can have harmful effects on fetuses and newborns. Research shows that Anafranil can lead to congenital heart issues and withdrawal symptoms in babies whose gestational carriers used the medication during pregnancy. 

Finally, if you have a history of depression or suicidal thoughts, talk to your doctor before starting Anafranil for OCD. 

Combining Anafranil with other OCD treatments

In many cases, Anafranil may be enough on its own to help people gain control over their OCD symptoms. In other cases, combining Anafranil with other medications can offer benefits. 

Recent research in the Journal of the Canadian Academy of Child and Adolescent Psychiatry found that combining Anafranil with Luvox (fluvoxamine), a selective serotonin reuptake inhibitor (SSRI), or a different class of antidepressant, can be an effective option for some. It’s important to note that this combination of medications can increase serotonin levels because of how they’re processed in the body. For that reason, whether you’re taking Anafranil or Luvox, when adding the other, your provider will do so gradually, starting with a low dose while monitoring your response. 

Another option you may consider with your provider is adding an antipsychotic medication like Abilify (aripiprazole), to boost the effects of Anafranil. The results of a double-blind, randomized, placebo-controlled trial were published in the Journal of Clinical Psychopharmacology. The study showed that the combination of Abilify and Anafranil was well-tolerated and helped improve OCD symptoms in people whose symptoms were previously treatment-resistant. 

Therapy can be an effective tool for managing OCD. Cognitive behavioral therapy (CBT) is an evidence-based approach for treating OCD. More specifically, Exposure and Response Prevention (ERP), a type of CBT, has the largest body of evidence for reducing OCD symptoms. 

Combining medication management and therapy can be a winning combination for OCD treatment. A study published in the American Journal of Psychiatry found that the combination of ERP and Anafranil was more effective at reducing OCD symptoms than Anafranil alone. 

Key Takeaway

Anafranil is an effective treatment option for treating OCD. The medication works by acting on the brain’s serotonin and norepinephrine levels, and research shows that Anafranil can be beneficial on its own, with other medications, or with therapy. 

While Anafranil can help people with OCD start feeling better, anyone considering the medication should be aware that there are side effects and risks that can occur with the drug. Talking to your provider about your symptoms and medical history can help you weigh your options, whether it be Anafranil or another medication like Prozac, Luvox, Zoloft, or Lexapro for OCD.  

Find a provider for OCD medication and/or therapy today

Connect with a provider today to learn more about your options for OCD medication and/or treatment, including Anafranil. 

Through Klarity, you can find an independent, compassionate, and trained provider ready to assess your symptoms and discuss treatment options. Take the next step to start feeling better. Find a provider through Klarity today!

The information provided in this article is for educational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health.

If you’re having a mental health crisis or experiencing a psychiatric emergency, it’s crucial to seek immediate help from a mental healthcare professional, such as a psychiatrist, psychologist, or therapist. You can also call your local emergency services, visit your nearest emergency room, or contact a crisis hotline, such as the National Suicide Prevention Lifeline, by calling or texting 988 or dialing the Lifeline’s previous phone number, 1-800-273-TALK (1-800-273-8255) in the U.S.

How we reviewed this article: This article goes through rigorous fact-checking by a team of medical reviewers. Reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the author.

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