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Taking Venlafaxine for OCD. Fear of physical attack and accidents. Worry about people reading thoughts. Depression

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Practicing since : 2004
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My problem is this I was diagnosed with severe OCD in my mid-twenties having shown signs of it since my mid teens (compulsive praying for example and a fear of being shot). I was treated with Venlafaxine for 3-4 years with mixed but generally positive results.
Now aged 42 however I wonder if my diagnosis was really as correct as it might have been. My main long running fear has been of some type of physicall attack, mainly by one person in particular (someone who bullied me - psycholgically mainly - for many years) but also by accidents such as a gas heater blowing up or a stone coming through your car windshield. Despite the fact I have had no contact from this person almost a decade I still can become well and truly blocked by these irrational tensions.
But symtoms have also included worrying that people could read my thoughts (I have never heard voices though), depression, terrible impatience and lack of concentration.
Bottom line:Even at 42 I still don't think im in control of this underlying paranoia and fearfulness. Despite the fact I have had no contact from this person almost a decade I still can become well and truly blocked by these irrational tensions. I'm back on Venlafaxine with no current success this time apparently. Many thanks
Posted Sat, 11 Aug 2012 in Mental Health
Answered by Dr. Ashish Mittal 6 hours later
Thanks for your query.

I appreciate your efforts for medical consultation in so much distress.

Important aspects of your query are:
•     42 year old male
•     Known case of obsessive compulsive disorder (OCD)

First there is no doubt regarding diagnosis of OCD in your case because of following reasons:
-You are seeking consultation on his own.
-Fear from person/accident and reading of thoughts indicate obsessive fear, as you are considering them irrational.
-You do not have any paranoid symptoms
-Presence of insight and treatment seeking

Some time patient did not improve with initiation of treatment, in that case one of the following steps are used:
-Wait for 4-6 weeks for response to occur.
-Increase the dose of current medicine to maximum tolerable doses.
-Change of existing medicine: Fluoxetine is good option.
-Addition of other medicine

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
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