clomipramine + nortriptyline

Clomipramine + nortriptyline is a combination of two tricyclic antidepressants, clomipramine and nortriptyline. Both drugs act primarily by inhibiting the reuptake of serotonin and norepinephrine at neuronal synapses, thereby increasing their levels in the brain. Clomipramine is a strong serotonin reuptake inhibitor with additional effects on norepinephrine reuptake via its active metabolite, while nortriptyline preferentially inhibits norepinephrine reuptake but also affects serotonin. This combination has been studied for use in obsessive-compulsive disorder (OCD), where it demonstrated greater efficacy than clomipramine alone, possibly due to synergistic enhancement of both serotonergic and noradrenergic neurotransmission[1][2][8]. Both agents also have anticholinergic properties and can block other receptors such as histamine H1 and adrenergic receptors.