Although up to 40% of ASD cases may be linked to genetic causes, it is not currently recommended to perform complete genetic testing on every individual who is diagnosed with ASD. Consensus guidelines for genetic testing in patients with ASD in the US and UK are limited to high-resolution chromosome and fragile X testing. Metabolic and neuroimaging tests are also not routinely performed for diagnosis of ASD.The age at which ASD is diagnosed varies. Sometimes ASD can be diagnosed as early as 14 months, however, a reliable diagnosis of ASD is usually made at the age of two years. Diagnosis becomes increasingly stable over the first three years of life. For example, a one-year-old who meets diagnostic criteria for ASD is less likely than a three-year-old to continue to do so a few years later. Additionally, age of diagnosis may depend on the severity of ASD, with more severe forms of ASD more likely to be diagnosed at an earlier age. Issues with access to healthcare such as cost of appointments or delays in making appointments often lead to delays in the diagnosis of ASD. In the UK the National Autism Plan for Children recommends at most 30 weeks from first concern to completed diagnosis and assessment, though few cases are handled that quickly in practice. Lack of access to appropriate medical care, broadening diagnostic criteria and increased awareness surrounding ASD in recent years has resulted in an increased number of individuals receiving a diagnosis of ASD as adults.
Some have suggested the possible superior efficacy of clomipramine compared to other antidepressants in the treatment of MDD, although at the current time the evidence is insufficient to adequately substantiate this claim. Panic disorder with or without agoraphobia. Body dysmorphic disorder
Cataplexy associated with narcolepsy. Which is a TGA and MHRA-labeled indication for clomipramine. Premature ejaculation
Depersonalization disorder
Chronic pain with or without organic disease, particularly headache of the tension type. Sleep paralysis, with or without narcolepsy
Enuresis (involuntary urinating in sleep) in children. The effect may not be sustained following treatment, and alarm therapy may be more effective in both the short-term and the long-term. Combining a tricyclic (such as clomipramine) with anticholinergic medication, may be more effective for treating enuresis than the tricyclic alone. TrichotillomaniaIn a meta-analysis of various trials involving fluoxetine (Prozac), fluvoxamine (Luvox), and sertraline (Zoloft) to test their relative efficacies in treating OCD, clomipramine was found to be the most effective. Contraindications
Contraindications include:
Known hypersensitivity to clomipramine, or any of the excipients or cross-sensitivity to tricyclic antidepressants of the dibenzazepine group
Recent myocardial infarction
Any degree of heart block or other cardiac arrhythmias
Mania
Severe liver disease
Narrow angle glaucoma
Urinary retention
It must not be given in combination or within 3 weeks before or after treatment with a monoamine oxidase inhibitor. (Moclobemide included, however clomipramine can be initiated sooner at 48 hours following discontinuation of moclobemide.) Pregnancy and lactation
Clomipramine use during pregnancy is associated with congenital heart defects in the newborn. It is also associated with reversible withdrawal effects in the newborn.