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Suggest Treatment For Recurrence Of OCD And Anxiety

Posted on Thu, 16 Apr 2015

Question: Hi Doctor,

I was diagnosed with OCD and anxiety a few years back. I have been taking medication since. I almost got over it but since the last few days I think the same has started coming back a little.

Answered by Dr. Chintan Solanki (1 hour later)

Brief Answer:
Recurrence may occur in OCD,tell more detail

Detailed Answer:
Hello,

Thanks for writing to us. I can understand your concern.

Almost 40% of patients with OCD have recurrent episodes.

According to guidelines if any medicines have worked well in past for some problem, same should be restarted again for treatment.

Please provide more detail regarding past symptoms with duration of treatment taken.

Also let me know when did you stop the medicines and since when symptoms reappeared.

Which are the current symptoms?How are they affecting your life?

Waiting for your reply to help you furhter.

Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (11 minutes later)

Hi Doctor,

I had mild OCD regarding my first born child. The thoughts were to cause harm to him which left me very uneasy and agitated. I consulted a doctor and was diagnosed with OCD. I was given Stelopam 10mg in the morning and Lonazep and Stelopam 10mg in the evening.

I have been taking the above said medicines since the last 1.5 years. From the last 6 to 7 days I have been feeling quiet dizzy and these thoughts have started reoccurring. Though I do not tend to feel that distressed with them now but my head is heavy all the time and even after a good nights sleep, I feel very sleepy during the day.

I have never stopped taking the medicine and the same still continues.

Please help me.

Answered by Dr. Chintan Solanki (42 minutes later)

Brief Answer:
Fluoxetine is good option, what is dose of lonazep?

Detailed Answer:
Hi XXXX,

Thanks for follow up and information.

Staolpam(Escitalopram) is not approved for OCD by FDA however it is useful in some patients of OCD and used off label sometime.But it should be increased up to 40 mg to be effective in OCD.
In OCD in general higher dose of SSRI medicines are needed than the doses used for depression.

Feeling of dizziness and sleepy mostly due to lonazep(clonazepam). It is a benzodizepine drug and can cause sedation.These may be side effect of escitalopram also.

What is the dose of lonazep in your case?

If I were your treating doctor I would like to stop lonazep/reduce the dose now and start fluoxetine for OCD rather than escitalopram.

Psychotherapy specifically CBT- Cognitive Behavior Therapy is also very much useful in OCD treatment.I would also like to use this approach with medicines.

Have you reported these recent problems to your treating doctor? If not, ask your doctor to examine in detail about your symptoms and discuss what I mentioned for changing the medicines.And revert back to me.

Feel free to ask if you have more queries.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (15 minutes later)

Sir,

My Lonazep dosage is .25 MG. I have been consulting a neuro doctor and not a psychiatrist. Maybe I should start consulting one. I have also read about CBT, but my thoughts are mild and do not trouble me much now.

But this dizziness has started happening since the last few days only and was not there since the last 1 year.

I will discuss these medications with my doctor today. Please advice.

Answered by Dr. Chintan Solanki (34 minutes later)

Brief Answer:
please consult psychiatrist, need of stopping the medicines

Detailed Answer:
Hi,

Thanks for info.

OCD is a psychiatric illness and very common in general population. Treatment of the OCD is done by Psychiatrist and not by Neurophysician in routine.

0.25 mg is low dose. But still possibility of side effects due to escitalopram can not be ruled out. We can check the same by stopping the medicines for a while.If they are side effect of medicines they will improve after stopping the medicines.
Side effects can occur later on also when after improvement drug dose is relatively high.

I request you to visit a psychiatrist also for detail evaluation of OCD. If it is mild OCD, with 3-4 sessions of detail counseling and psychotherapy you can be improved and no need of medicines will be there.

Hope this answer is helpful.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Chintan Solanki (18 minutes later)

thank u sir, i will consult my treating doctor and a psychoatrist as well and then shall get back to u on the same. but just wanted to know that can i completely get cured of this dreadful disease?

Answered by Dr. Chintan Solanki (2 hours later)

Brief Answer:
yes you can get cured

Detailed Answer:
Hello,

Thanks for follow up.

OCD prognosis is variable. In 30-40% of the patients first episode is last episode. In other 30-40% recurrent episodes are there but they can be controlled with medicines. In other 20-30% of the patients it is very severe disease and difficult to treat.Prognosis depends on various factors like age,sex, type of OCD, treatment used, family history, education and mindfulness of the patient and psychotherapy used.

Considering your history you provided here I think you will be cured and there will be no recurrence. But confirmed answer can be given after detail evaluation by a Psychiatrist. For that detail history and mental status examination are needed.

Hope I have answered your query. If still any query there, I will be happy to answer. If not, you can close the discussion and if feasible give your feedback so I can improve service. In future you can contact me directly on this site if you wish with this link: http://bit.ly/drchintansolanki

All the best and wish you good health.
Dr.Chintan Solanki.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar