Clomipramine in the elderly: tolerance and plasma levels.

Five elderly, treatment-resistant, depressed, female patients were closely monitored in a research setting during treatment with clomipramine. Plasma clomipramine levels were determined to establish a steady state. Elderly patients (67 to 80 years old) reached a therapeutic steady state at doses lower than that reported for midlife patients. Overall, clomipramine was well tolerated in this group. Depression, measured by the Hamilton Rating Scale for Depression, decreased 42%, and the frequency of somatic complaints, measured by the Rating Scale for Side Effects, declined by 57%. Clomipramine is specifically indicated for the treatment of obsessive-compulsive disorder and may be an alternative for elderly depressed patients, provided that lower doses and plasma clomipramine monitoring are used.