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Suggest treatment for OCD

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Posted on Tue, 9 Sep 2014
Question: i was diagonized ocd long back back,while in child hood i use to do repetetive things nd al,,but al those i stopped at the year 2000 i think.But i take medication from past 18 years , i dont remember the previous medicines names .. for last 2 yrs i was taking nexitofort.but still i felt obsession thoughts ,but worse thing about me is i feel hungry when i feel tensed .so i use to recover that situation by eating food in my earler stages .now a days i dont eat..so recently i consulted with other phsycartist he prescribed fluvaximine 50 nd later 100 mg ,at the same time he dropped nexitoforte. Initially i feel more energetic my thinking was good i felt fresh .but at sometimes i feel depressed ,i use to have many doubts.. i got side effects like over sweating then gradualy stopped ,after that i suffered muscle twitching ..so again i consulted previous phscartist so he prescribed nexito LS & xet cr 12.5 at night .So its been 10 days now having nexto & xet cr 12.5 .i gradually got improvement in obsession thoughts.but i use to drink alchohol twice in a month . so day before when i had alchohol i got reverse action i feel iam doing repetetive action with neck might be obsessive compulsive but no one is noticing that .. i feel headache also .. so iam very confused wheather this two medicines are right combination for me .consuming alchohol ocassionaly also effect the health ?Mean while iam a sucessfull Business man too ,that means iam doing my job .. but now a days iam confused with medication which one to go. And i have genetical history ..my father have anxiety probs he also having medication from long years . so i want good advise which should help me.note i even stopped all medication for 10 days .. at that time i feel more energy one me . but later i was not confident enough to move forward .. so should i stop the medication ?..
doctor
Answered by Dr. Chintan Solanki (35 minutes later)
Brief Answer:
You can stop medicines after sometime.

Detailed Answer:
Hello,

In OCD30% patients become stable with medicines and there is no further episode.
In 30% there are recurrent episodes and each time they improve with medicines. In 20% medicines have to be taken for long as without medicines they are not stable. And in remaining 20% even after medicines, no stability.

You are absolutely not in any 20% as I mentioned.

Treatment of OCD has two parts.

Medicines and Psychotherapy.

Medicines: SSRI(Selective Serotonin Reuptake Inhibitor - Fluoxetine, Fluvoxemine, Sertraline, Paroxetine, Escitalopram)

They are used in higher doses than doses used in treatment of depression.

Nexito(Escitalopram) is least used for OCD among them. Fluoxetine and fluvoxemine are frequently used.
You are on Nexito and xet(paroxetine), both are good choice. If you are stable on that, please continue for now. If not ask your doctor to shift to fluoxetine.

Psychotherapy: Many different therapies are there for OCD depending upon symptoms. CBT(Cognitive behavior therapy is the best in my opinion. If you are good motivated and your therapist is skillful CBT can cure OCD and you can be stable without medicines.

In your case I think you should start simultaneously CBT with current medicines. As you become stable, medicines should be tappered off and stopped gradually.

Alcohol if taken once or twice in optimum amount(not more than 30 ml of 40% alcohol) is not going to affect your OCD outcome or health. But if frequency increased up to once or twice in a week, it can affect your treatment part.

Hope I have answered your query, I will be happy to help further if needed.
regards,
Dr. Chintan Solanki.
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Chintan Solanki (31 hours later)
Hai Dr

Thank you for your detailed reply.now
I think when i mentioned ocd to my new doctor he changed medicine to fluvoxamine from nexitoforte and he said he wont prescribe medicine contain clonozapam ,he even said fluvoximine tab will improve brain nd treat ocd .So after having fluvaximine even i felt energy i use to think perspective way lot more ideas use to come for my business more concentration,later stages i felt more
confusion ,sweating ,muscle twitching ..more anxiety about my business .Then i consulted previous doctor who prescribed nexitoforte itself .but again i said to this doctor also about ocd and said i had fluvoximine for last six months,so he reduced nexito forte to nexito LS nd intoduced xet cr 12.5 .but now iam facing more problem ,i use to correct my neck from shirt collar in repetetive manner later my neck started paining,I dint have this much problem before ,when i use to take nexito forte .So i think i hv mix of anxiety nd ocd .so i think my medication should be like that.
And i noticed when iam having nexitoforte iam more comfortable ,But at that point of time i use to have anxiety like when my shirt goes up i feel discomfortable while sitting in public thinking someone will see my back side..so i feel stressed ,this was there al the time when i had nexito forte for 2 yrs ,so i want to ask you is it ocd or anxiety bcoz I dont do anything to correct the shirt .so to get free from that type of stress only i consulted new doctor ,so he prescribed fluvoximine 50 mg gradualy turned to 100 mg .from that movement i started confusing with more medicines.
Note : why i said iam ocd patient bcoz in my child hood i do repetetive things later i was diagonised with ocd and even had behavioral therapy. But it al hapend long back .after that i completed mba nd started business suceeded ,married now i hv two kids .But its been 6 months back when i changed nexitoforte it all happend.so pls suggest right medication .
doctor
Answered by Dr. Chintan Solanki (8 hours later)
Brief Answer:
See below

Detailed Answer:
Hello
Thanks for follow up question.

I would like to suggest fluoxetine to start with 20 and gradually increased up to 80 if needed.
Simultaneously etizolam , a good anti anxiety without sedation, in dose of 0.25 to 0.5 two - three times a day and gradually tapper off.
You can discuss more about these medicines with your doctor. If etizolam is not available there clonazepam is good alternative.

The best thing is psychotherapy with medicines. As I used to go with both in my patients and results are there. With psychotherapy your medicines can be decreased and even stopped later on.

I hope I have answered your query, if still any confusion late me know.

All the best.
Regards, Dr. Chintan Solanki.
Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
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Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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Suggest treatment for OCD

Brief Answer: You can stop medicines after sometime. Detailed Answer: Hello, In OCD30% patients become stable with medicines and there is no further episode. In 30% there are recurrent episodes and each time they improve with medicines. In 20% medicines have to be taken for long as without medicines they are not stable. And in remaining 20% even after medicines, no stability. You are absolutely not in any 20% as I mentioned. Treatment of OCD has two parts. Medicines and Psychotherapy. Medicines: SSRI(Selective Serotonin Reuptake Inhibitor - Fluoxetine, Fluvoxemine, Sertraline, Paroxetine, Escitalopram) They are used in higher doses than doses used in treatment of depression. Nexito(Escitalopram) is least used for OCD among them. Fluoxetine and fluvoxemine are frequently used. You are on Nexito and xet(paroxetine), both are good choice. If you are stable on that, please continue for now. If not ask your doctor to shift to fluoxetine. Psychotherapy: Many different therapies are there for OCD depending upon symptoms. CBT(Cognitive behavior therapy is the best in my opinion. If you are good motivated and your therapist is skillful CBT can cure OCD and you can be stable without medicines. In your case I think you should start simultaneously CBT with current medicines. As you become stable, medicines should be tappered off and stopped gradually. Alcohol if taken once or twice in optimum amount(not more than 30 ml of 40% alcohol) is not going to affect your OCD outcome or health. But if frequency increased up to once or twice in a week, it can affect your treatment part. Hope I have answered your query, I will be happy to help further if needed. regards, Dr. Chintan Solanki.