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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Insomnia And OCD After Taking Citalopram And Trazadone For Severe Anxiety. History Of Intake Of Several Medications For Anxiety And Depression. Suggest

I have been on several meds for insomnia, depression, anxiety, from the amitriptyline, nortripylines and other tryptylines to klonopin with klonopin being the longest and the most difficult to get off of. Since weaning myself of it nearly 18 months ago I have had terrible anxiety and OCD started shortly afterwards. I am currently on citalopram and trazadone. The trazodone, I am still experiencing insomnia and OCD. What can I do?
Wed, 31 Jul 2013
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  User's Response
Anxiety disorders and OCD can be recurrent and relentless sometimes as in your case. SSRIs are the drugs of choice (citalopram) in anxiety as well as OCD. However, the dose needed to treat OCD is higher than that needed to treat anxiety and depression alone.

You may not respond to the first SSRI given to you. So, if citalopram has not given you symptoms relief even after an adequate dose has been taken regularly without fail and for at least 12 weeks, your doctor may consider dose changes or a change of your medications.

You may need to consult your psychiatrist again and discuss about these options.
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Psychiatrist Dr. Dr.Nehal's  Response
Hi,
Thanks for using healthcare magic.

I have gone through your available history.

In OCD, there are two types of treatment available.
1) Anti obsessive agents like selective serotonin reuptake inhibitors like escitalopram , fluoxamine or tetracyclic anti depressants ike clomipramine

2) Psychotherapy like exposure and response prevention

As you have mentioned that you still have obsession and insomnia, the reason might be due to
- Inadequate dose of SSRI
- Poor compliance on your part
- other psychiatric diagnosis like substance use
- Physical causes
So, You should consult your psychiatrist to find out the reason for non-improvement. Treatment should be directed as per cause.

In many patients , combined drugs and psychotherapy is very helpful.

Thanks.


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 1 user finds this helpful

Psychiatrist Dr. Sundar Gnanavel's  Response
Hello....
Thanks for your query. The treatment options for OCD include:
1. Anti-obsessive agents like fluoxetine
2. Psychotherapy interventions like ERP/ Exposure and response prevention
I would suggest that a combination of the above modalities might suit your case. Clonazepam is long acting sedative and needs to tapered gradually over 2-3 months. Contact your psychiatrist at the earliest to discuss these options. Wish you speedy recovery.
Regards
Dr Sundar
Psychiatrist
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Insomnia And OCD After Taking Citalopram And Trazadone For Severe Anxiety. History Of Intake Of Several Medications For Anxiety And Depression. Suggest

Anxiety disorders and OCD can be recurrent and relentless sometimes as in your case. SSRIs are the drugs of choice (citalopram) in anxiety as well as OCD. However, the dose needed to treat OCD is higher than that needed to treat anxiety and depression alone. You may not respond to the first SSRI given to you. So, if citalopram has not given you symptoms relief even after an adequate dose has been taken regularly without fail and for at least 12 weeks, your doctor may consider dose changes or a change of your medications. You may need to consult your psychiatrist again and discuss about these options.