Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

144 Doctors Online
Doctor Image
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Suggest treatment for OCD and anxiety

Answered by
Dr.
Dr. Sunil Gupta

Psychiatrist

Practicing since :2005

Answered : 637 Questions

default
Posted on Tue, 2 Sep 2014 in Bipolar Disorder
Question: I am on Keppra 1000mg as mood stabilizer, Lexapro 5 mg for five days (i was for some years on Lexapro 2.5 mg), Klonopin 2mg and Amisulpride (Solian) 100 mg. Since i have anxiety but also some symptoms of OCD, my psychiatrist decided to give a higher dosage of Lexapro, from 2.5 mg to 5 mg.
It's important to say that i am a poor metabolizer for cyp2c19 and mild for cy2d6, so i would like to know if i can expect in 20 o 30 days with Lexapro 5 mg the same effect antiOCD as people who takes 10 mg with a normal metabolism, or if i need to discuss with my psychiatrist a higher dosage.
doctor
Answered by Dr. Sunil Gupta 34 minutes later
Brief Answer:
Higher dose is recommended.

Detailed Answer:
Hi,

I went through your query in detail and can understand your concern. Lexapro is escitalopram and is a selective serotonin reuptake inhibitor. Of all the medications that you are taking, it is the one medications which is used as a front line agent for OCD and anxiety. The usual dose range for Escitalopram is 10-20 mg. So, despite the fact that you are a poor metabolizer, 2.5 mg of escitalopram was a very low dose to b eon for years.

It was a right decision to hike the dose. Generally, higher doses of escitalopram (20 mg/day) is required in OCD patients. I would prefer to increase the dose in 2-3 week time, if there is none or very minimal response to it. Normally, it can be increased at 5 mg at a time. In your case, I would suggest to increase it at 2.5 mg at a time to make sure that no adverse effects occur.

Although you are a poor metabolizer, I would even consider increasing it to even 20 mg/day if you don't have any side effects with the gradual increase in dose. Development of side effects should be the only criteria of not going up further than a particular dose. To make sure, you don't have nay side effects, the dose can be increased 2.5 mg at a time, as suggested.

You can discuss regarding this with your psychiatrist and consider the options. I do hope that I was able to answer your query. Please feel free to ask any further query that you may have.

Best wishes,

Dr. Sunil Gupta


Above answer was peer-reviewed by : Dr. Yogesh D
doctor
premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions
Drug/Medication ,  
Medical Topics ,  

Recent questions on  Mood stabilizer

doctor1 MD

My father is an epileptic for the past 50 years.He is taking lobazam 10 mg along with other antiepileptic drugs such as eptoin , gardinel sodium 10 mg etc.for more than 20 years. He is now 92. !0 days before he was so week and admitted in the hospital doctors stopped for a while lobazom & gardinel sodium 10 mg. Now he is restless and behaves some what abnormal? So today we started giving again these two tablets? Is these behavioural disorders are due to the sudden stopping of these tablets? What can we do now? Please help me by replying.Thank you.

doctor1 MD

I m choking on valproic acid often, can t breathe and then wheezing, gagging and coughing for a few minutes and later more gagging for an hour or more. VA MD neurologists prescribed it for me for rare seizures a few years ago, was taking dilantin then for a year and dentist told me to get off of it. Depakote tablet was too big to swallow, choked on a smaller calcium tablet and self-heimliched to get it to swallow, not up. I have a hiatal hernia, VA Dx primary progressive multiple sclerosis, Mayo Dx atypical spinocerebellar degeneration and another MD Dx spinal cord stenosis, suggesting my time in Korea may have contributed to my conditions and disease from herbicides. I m 67, weak an have many other irritating Sx, cannot sleep properly. I have just quit valproic acid and neurontin, earlier quit baclofen as both no longer gave me any relief from muscle spasns and stabbing pains all over my body.

doctor1 MD

My 6 yrs old child on 19 Aug 10 fallen down from swimming pool ramp and left side of his head struck at my knee. after 40 min he got vomited and seized, as reached hospital, a fracture left side of head above the ear and struck spot was press down abt 2 cm inside in CT Scan report.He admitted for two days and given eption medicine for next six month after three month dr. adv EEG test to change in above mentioned medicine bcoz of its side-effect now Dr.given valproate 200mg & oppineuron You pls suggest what ur views

doctor1 MD

..i have epilepsy my petit mals are really bad when menstuating always day 4 and on my fertile days day 11 12 13 14 of ovulation is there anything i can take to control my hormones imm currantly taking keppra and epilim

doctor1 MD

I have an very severe anxiety disorder and am taking 5mg of diazepam twice a day and it is not helping me that much with my anxiety.....One dr. gave me zoloft several years ago, and worked well except for weight gain. I have a new dr. right now...

doctor1 MD

My 26 yr old son was depressed at the beginning of th year and was prescribed prozac . This precipitated manic episode from mar-jun, during which he was taken off prozac, put on lithium (450) mg, then fell into a severe depression . He was then...

doctor1 MD

Would a doctor prescribe Zoloft and depakote at the same time for severe depression?