Resolved question:
I'm based in the UK. I have severe obsessive compulsive disorder. I've been on 40mg of Paroxetine for the past 1 year. I've decided to switch to Clomipramine (a tricyclic) because I've heard it's good for OCD. My doctor has started me on 25mg of Clomipramine and has told me to reduce the dose of Paroxetine from 40mg per day to 20mg a day for 1 month and then to stop taking the Paroxetine completely after 1 month. Is this safe? What do you recommend? Also, is clomipramine considered to be effective for OCD? What is the difference between the Tricyclic anti-depressants and the selective serotonin reuptake inhibitors? How long will the paroxetine stay in my system and will it inhibit the effectiveness of the clomipramine?
Submitted:
4 Days
Category:
Psychiatrist
Hello,
Thanks for posting your query at DoctorSpring.com
I have gone through your question in detail and I can understand what you are going through.
Clomipramine and paroxetine are good medicines for OCD and are almost equally effective. Some patients respond well with paroxetine and some respond well with clomipramine. We cannot say if any of these two drugs is superior.
Coming to the cross tapering, what your psychiatrist is said is not wrong but there are couple of things which i would like to suggest which you can discuss with your doctor:
1) Stopping paroxetine at 20mg abruptly may be avoided. Instead one more step of reducing the paroxetine to 10mg and then stopping it after 1 week is a better idea.
2) When in between you are on both clomipramine and paroxetine, you need to look out for the possibility of serotonin syndrome which is a side-effect of combining the TCA and SSRI.
3) Sedation can be more.
4) Paroxetine will stay in the system for 24-48 hours after stopping the medicine totally.
Hope this helps,
In case if you have any further query, do let me know.
Kind regards
Dr. Srikanth Reddy
Thank you for your reply.
What are some of the signs of serotonin syndrome? Is it likely to occur or unlikely? I've been taking the 25mg of clomipramine for 3 days and cut down to 20mg of paroxetine 3 or 4 days ago. Should I suggest to my GP to cut down to 20mg after one month and then 10mg for a week or so? Will the effectiveness of the clomipramine be inhibited because I'm taking it in conjunction with paroxetine? Will I have to be off the paroxetine completely before I notice any beneficial effects of the clomipramine?
Also, what is the difference between tricyclic anti-depressants and SSRIs? Why do doctors rarely prescribe tricyclics and prefer to prescribe SSRIs?
Thank you.
Hello
Here are the answers that you want:
What are some of the signs of serotonin syndrome? Is it likely to occur or unlikely?
ANS: Its not likely but one needs to be careful and cautious. The symptoms of serotonin syndrome are
I've been taking the 25mg of clomipramine for 3 days and cut down to 20mg of paroxetine 3 or 4 days ago. Should I suggest to my GP to cut down to 20mg after one month and then 10mg for a week or so?
ANS: You may ask your GP to cut down to 20mg over next week and then to 10mg over the next week and then to 5 mg after 1 more week and then stop.
Will the effectiveness of the clomipramine be inhibited because I'm taking it in conjunction with paroxetine? Will I have to be off the paroxetine completely before I notice any beneficial effects of the clomipramine?
ANS: No. Clomipramine may act even in presence of paroxetine.
Also, what is the difference between tricyclic anti-depressants and SSRIs? Why do doctors rarely prescribe tricyclics and prefer to prescribe SSRIs?
ANS: SSRIs are newer drugs with lesser side-effect profile and hence doctor prefer SSRIs. Both are the groups of antidepressants and structure of SSRI and TCA are different and SSRIs are relatively more safer.
Hope these answers help you.