Brief Answer: Explained below. Detailed Answer: Hi, Welcome to Healthcare Magic! Social anxiety disorder and OCD are both anxiety disorders. Since anxiety itself can cause difficulty in focusing and concentrating, I feel that you should not worry about the diagnosis of adult ADHD until your anxiety is gone and you still notice that there is some difficulty in concentrating. Moreover, for the diagnosis of adult ADHD, it is required that you should have had ADHD as a child as well. As you must be knowing, OCD is characterized by repetitive, intrusive, absurd, unwanted, anxiety provoking thoughts (obsessions) and often repetitive activities (compulsions) as well. Compulsions are undertaken to relieve the anxiety associated with obsessions. In some people, OCD itself leads to social anxiety as people feel uncomfortable in the company of others because they fear that their compulsions will make them a subject of ridicule among others. If this is the root cause of social anxiety in your case, then you need to focus only on the treatment of OCD. Once OCD is under control, the social anxiety will improve by itself. Supposing both OCD and social anxiety are independent disorders in your case, even then much change is not required in the treatment strategy. OCD is usually treated with the SSRI class of medicines (fluoxetine, sertraline etc) which give very good results in social anxiety disorder as well. In addition, you can use propranolol on a SOS basis before meetings, interviews etc to control the tremors, sweating, numbness, tingling etc are often felt by people with social anxiety disorder, whenever they are in social situations. Apart from medical treatment, psychotherapeutic interventions are also available. Exposure and response prevention is usually practiced for OCD but the exact type of psychotherapeutic intervention would depend on what are the symptoms of OCD in your case. There are psychotherapeutic interventions for social phobia also. I shall be able to help you better if you can let me know the following details: 1) Since when have you been having OCD and what symptoms of OCD do you have? 2) What are the symptoms that you call social anxiety? Are these generalized or occur only in specific situations like public speaking etc? 3) What treatment you have taken so far for these and what was the response? Please also let me know the dose of the medicines you have tried and for how long. Please get back to me with these details. Please also let me know if you think that your social anxiety is independent or secondary to OCD. Best wishes. Dr Preeti Parakh MD Psychiatry

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Brief Answer: Explained below. Detailed Answer: Hi, Thanks for the details. You are right in saying that both OCD and social anxiety lower one's productivity a lot and need to be treated effectively. Your treatment history shows that you have been treated with more anti-psychotics than with SSRIs which should have been the first line of management. Your list only has three SSRIs, Fluvoxin, Daxid and Paxil CR. The doses of Paxil CR and Daxid that you have mentioned are just the starting doses and not likely to benefit much in OCD which requires higher dosages. You have not mentioned the dose of Fluvoxin, but perhaps you did not take it for long. SSRIs do not cause sedation, but it is possible that other medicines like serenace, mozep, sizodon etc were prescribed with the SSRI and caused sedation. As a result, you stopped all medicines yourself, blaming them for the sedation. I would have preferred to treat you only on an SSRI, either fluoxetine or fluvoxamine with propranolol to be used on a SOS basis for interviews, meetings etc. The problem with SSRIs is that they take a few weeks to show their response and people often discontinue them before that, thinking that they are ineffective. Also the dose needed for OCD is higher than that needed for other disorders. These medicines are also the first line agents for management of social anxiety, so you do not need any other medicine in addition for social anxiety. Psychotherapeutic interventions work in both OCD and social anxiety, but they are more effective in people with predominantly compulsions. In your case, I feel that not being on medicines is not a sensible decision and you should start a SSRI as soon as possible, preferably fluoxetine. It is cheaper than fluvoxin and very effective. For psychotherapeutic interventions, you may find it difficult to find a doctor who practices these as they are time consuming and take a lot of time. However I know a psychiatrist in Mumbai who did her postgraduation in Psychiatry from PGIMER, Chandigarh and is now a XXXXXXX resident in department of Psychiatry in TNMC and BYL XXXXXXX Hospital, Mumbai. Her name is Dr XXXXXXX Somaiya. She was a junior of mine while I was doing my XXXXXXX residency in PGIMER, Chandigarh and I personally know that she is good in both pharmacological and psychotherapeutic interventions. If you wish you can contact her for both. I have deliberately not given you any big names as they are not likely to be able to help you with psychotherapy and you may also find that they do not listen to you! This time, if you have any problems with medicines, talk to your doctor, rather than stopping the medicines yourself. Best wishes. Dr Preeti Parakh MD Psychiatry

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