Hello and welcome to Healthcare Magic. Thanks for your query.

I will certainly advise and guide you regarding your problem. In order to understand your problem better, please provide the following clarifications...

How long have you been having this problem?

How did it start? (suddenly or gradually?)

Do you have any other O-C symptoms?

How much of dysfunction is this problem causing you and in what way?

How long have you been on medication?

Have you been tried on any other medication? If so, what was the response?

Have you been tried on psychotherapy?

Are you under any stressful situation recently?

Do you have any other symptoms like feeling low, decreased energy, lack of interest, negative thoughts, poor sleep and appetite?

Do you consume alcohol or any other substances of abuse?

Do you suffer from any known medical problems or are you under any treatment currently?

Please get back to me with these clarifications, so that I can advise you in a better way.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist

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Hello again and thanks for your clarifications.

I can understand that you are going through a difficult time with your psychiatric problems, namely OCD and Depression. Nexito (Escitalopram) is an SSRI anti-depressant and SSRIs are the first choice in treating OCD. Now, typically, for the treatment of OCD, large doses of SSRI medication is required - usually 3 to 4 times the doses used to treat depression. So, you may require higher doses of Nexito to control your OCD symptoms. Though many people respond well to first time anti-depressant medication, there will be a proportion of people who respond only partially or have a poor response to treatment. In such cases, a different class of medication has to be tried or a combination of medication has to be tried. There are plenty of treatment options available, but each of them have to be systematically tried. So, please don't get dejected that you don't seem to be responding to your anti-depressant.

In resistant cases of OCD, a particular antidepressant called Clomipramine has been found particularly effective. Also, whenever there is treatment resistant OCD or depression, the patient also needs to be investigated for any causes for treatment resistance, for example, certain medical causes, like thyroid problems, certain vitamin deficiencies, etc. can be contributory. If so, they have to be detected and treated appropriately. Further treatment options include trying different combination of anti-depressants, augmenting the antidepressant with other psychiatric medication like an anti-psychotic or a mood-stabilizer, thyroxine supplementation, etc. Also, a combining medication with intensive psychological therapies, such as Cognitive Behavioural Therapy(CBT) can yield good results. As a last resort, when different medication and psychotherapy fail (very rare possibility), Electro-convulsive Therapy (ECT) can also be used as an option.

So, don't get dejected or give up hope at all. Please discuss the various treatment options with your doctor and stay positive till your doctor is able to find you a suitable form of treatment that works out. This can take some time because each option must be systematically tried before writing it off and often anti-depressant medication can take a few weeks to bring about their full potential. It is also important that you have some vents for letting out your steam periodically and relaxing yourself, so that you don't get very stressed out. It is a good idea to keep talking to someone close and sharing your feelings, as this can be a good de-stressor. I am confident that that with appropriate therapy and good motivation from your side, you will surely be able to overcome your problems soon.

Wish you all the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist

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