Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
1 drug selected — Clomipramine(click to collapse)
1/4 selected
Clomipramine
Anafranil · Caniquell
Tricyclic Antidepressant
FDA-approved indications
- Obsessive-compulsive disorder (adults; children/adolescents 10+)
Off-label uses
- Body dysmorphic disorder
- Panic disorder
- Premature ejaculation
Half-life19 to 37 hours (desmethylclomipramine: 54 to 77 hours)
Decision GuideWhen to pick each / when to consider an alternative
Clomipramine
Consider when
- Obsessive-compulsive disorder — only TCA FDA-approved for OCD (adult and pediatric ≥10 years); gold standard prior to SSRI era
- OCD refractory to SSRIs — established second-line after SSRI failure; most serotonergic TCA (true dual SRI/NRI via parent + metabolite)
- Cataplexy in narcolepsy (off-label) — effective for cataplexy; unique niche among TCAs
- OCD with comorbid depression — dual serotonergic + noradrenergic action addresses both conditions simultaneously
- +1 more
Consider an alternative when
- Sexual dysfunction is a concern — worst among all antidepressants: ejaculation failure 42% vs 2% placebo; orgasm OR 18.45 (Serretti 2009)
- Seizure risk present — highest seizure incidence among TCAs (1.45%/year); contraindicated in seizure disorders
- Tolerability is the priority — worst acceptability of all 21 antidepressants in Cipriani 2018 NMA
- Anticholinergic-vulnerable patient — dry mouth 84%, constipation 47%, urinary retention 14%; near-universal anticholinergic burden
- +1 more
| Axis | Clomipramine TCA |
|---|---|
| Boxed Warnings | |
Suicidality (boxed warning) | |
| CNS | |
Sedation / somnolence | |
Seizure risk | |
| Metabolic | |
Weight gain | |
| Autonomic | |
Anticholinergic burden | |
Orthostatic hypotension | |
Sweating | |
| Cardiac | |
Cardiac conduction / AV block | |
Blood pressure elevation | |
Heart rate / tachycardia | |
| GI | |
Nausea / GI (general) | |
| Hepatic | |
Liver enzymes / hepatotoxicity | |
| Electrolytes | |
Hyponatremia / SIADH | |
| Sexual | |
Sexual dysfunction | |
| Discontinuation | |
Withdrawal / discontinuation | |
| Interactions | |
Serotonin syndrome risk | |
CYP interactions / DDI profile | |
| Safety | |
Overdose toxicity | |
| Pregnancy | |
Lactation / breastfeeding safety | |