A Psychological and Physiological Evaluation of the Effects of Intravenous Clomipramine (Anafranil)

Clomipramine has been considered to have specific actions in alleviating chronic depres­ sion, obsessive-compulsive disorders and phobic anxiety, especially when these symp­ toms had proved refractory to other types of treatments. The investigators who have made these claims have usually given the drug intravenously, often in high dosage, and some workers have reported on the rapidity with which affective disorders have been improved. Sigwald & Raymondeaud (1966) treated eighty depressed patients with clomi­ pramine infusions and commented on its rapidity of anti-depressant effect, and an apparent immediate anxiolytic action as well. Marshall (1971) has used intravenous clomi­ pramine for treating phobic anxiety states and described relief of anxiety possibly associated with an immediate elevation in mood. In 1968 van Renynghe de Voxvrie noted an anti-obsessional effect of clomipramine in fif­ teen obsessive-compulsive patients, and in 1970 Lopez Ibor reported on twenty-nine obsessive-compulsive patients who had been given large amounts of the drug intravenously (300 mg). The patients had been chronically ill patients (mean duration of illness 9-6 years), and did not respond rapidly, some improving only after forty-five daily infusions (mean 20). Nevertheless, he described marked physiological and subjective reactions to the infusions, sometimes reaching the propor­ tions of what he previously called 'vegetative shock', with hypotension and somnolence. Others have reported sedation, hypotension and epileptic seizures (Brandner 1964, Symes 1967, Carney & Black 1967).