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Suggest treatment for OCD and anxiety

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Psychiatrist
Practicing since : 2005
Answered : 637 Questions
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.
Posted Sun, 31 Aug 2014 in Bipolar Disorder
 
 
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

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