Clomipramine for obsessive-compulsive disorder.

Obsessive-compulsive disorder affects about 2 percent of the U.S. population and can be quite disabling. Clomipramine is the only drug approved for the treatment of obsessive-compulsive disorder. Its efficacy is unique among tricyclic antidepressants and may be related to its relatively high potency in affecting serotonergic neurotransmission. The drug has many anticholinergic effects, but it is relatively well tolerated by the patients for whom it is effective. A 0.4 percent incidence of seizures, a potentially serious side effect, has been observed. Other antidepressants that are relatively selective for serotonergic (as opposed to noradrenergic) transmission may be as effective as clomipramine in the treatment of this disorder; controlled studies are under way. Clomipramine at low doses is also effective in the treatment of panic disorder and has been used successfully in the treatment of premature ejaculation.