Antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (18-24 years of age) with major depressive and other psychiatric disorders. Clomipramine is FDA approved for the treatment of obsessive-compulsive disorder in children ≥10 years of age. May worsen psychosis in some patients or precipitate a shift to mania or hypomania in bipolar disorder. Clomipramine is not FDA approved for the treatment of bipolar depression. May cause anticholinergic effects (constipation, xerostomia, blurred vision, urinary retention); use with caution in decreased gastrointestinal motility, paralytic ileus, urinary retention, BPH, xerostomia, or visual problems. The degree of anticholinergic blockade produced by this agent is very high relative to other antidepressants. May rarely cause bone marrow suppression. May cause orthostatic hypotension (use with caution in cerebrovascular disease, cardiovascular disease, hypovolemia, or concurrent medication use which may predispose to hypotension/bradycardia). May cause seizures (use with caution in previous seizure disorder or condition predisposing to seizures such as brain damage, alcoholism, or concurrent therapy with other drugs which lower the seizure threshold). Has been associated with a high incidence of male sexual dysfunction. May cause weight gain. Use with caution in history of cardiovascular disease (risk of conduction abnormalities is high relative to other antidepressants). Use with caution in hepatic/renal impairment. Use with caution in patients with hyperthyroidism or those receiving thyroid supplementation due to concerns of pro-arrhythmogenesis. Hyperpyrexia has been observed with tricyclic antidepressants in combination with anticholinergics and/or neuroleptics, particularly during hot weather. Effects may be potentiated when used with other sedative drugs or ethanol. Use with caution in the elderly. Recommended to discontinue prior to elective surgery requiring general anesthesia. Therapy should not be abruptly discontinued in patients receiving high doses for prolonged periods. May increase the risks associated with electroconvulsive therapy.