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Dr. Andrew Rynne

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Suggest treatment for Obsessive–compulsive disorder

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Dr. Jonas Sundarakumar

Psychiatrist

Practicing since :2003

Answered : 2190 Questions

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Posted on Tue, 26 Aug 2014 in Sexual Health
Question: hi doc
i have visited my local pschiatrist and is under his treatement for last 2 months and being digonsed with OCD and phobia.
i am on daxid 50in morning and recita forte which is escitalapram 10mg and clonazeparm .5 mg in night.
The reason why i am dignosed with OCD is that 2 years back i had been piked with a needle in one of a metro which gave me a impression that may be the poked needle is hiv contaminated therefore i was in doubt but for 1 and half year i did not take that seriously but in the month of feb 2014 i had a fever and which last for around 15 days at that point of time i was totally depressed with the thought that i have hiv but later in the month of april i had gone for the test and the test was negative.
But unfortunately the things did not stop here obsessive thoughts like might the patholab might have used the used needle which might be contaminated with hiv and also whenever i go to salon for saving always this thought comes to me if the blade might be used earlier on any other person who might be contaminated with hiv and even i continously use to check my weight and do all kind of compulsive act like again i have gone for a test 15 days back which was also negative.
now things are bit ok but still whenever i go to salon or i think again i might have been contaminated with which i know is not practical.

am i with the right drug as i consult other doc they ask me to enance the ssri but my existing doc show a trembling effect in my hand which also is a childwood problem but which has enanched now so he told me that serotinin level seems to be stablized there not to enance ssri further.
suggest me plz

this time the new psychiatrist had prescribed me zeptra 25 in night and daxid 100 in morning and he also told me that fluvoxine 100 will be better for me but i denied it bcoz i had once consumed fluvoxine 100 but due to side effect i discontiued

now suggest me to go with the existing daxid 50 and recita forte with the old doc
or
daxid 100 and zeptra 25 in night
also this doc told me this anxeity is created by myself bcoz i search in the net for all such stuff and get involved in to depth which is not my piece of cake but sorry its a nature which i am unable to change



doctor
Answered by Dr. Jonas Sundarakumar 1 hour later
Brief Answer:
Second option is relatively better...

Detailed Answer:
Hello and welcome to Healthcare Magic. Thanks for your query.

From the description of your symptoms, it appears that you are suffering from OCD. Now, regarding the choice of medication among the options that you have given:
- Option 1 Daxid (Sertraline) 50mg and Recita Forte (Escitalopram 10mg + Clonazepam 0.5mg)
- Option 2 Daxid (Sertraline) 100mg and Zaptra 25 (Paroxetine 25mg + Clonazepam 0.5mg)

Both options are somewhat similar because Setraline, Escitalopram, and Paroxetine are all SSRIs which are effective in the treatment of OCD. But my opinion is that Option 2 (Daxid (Sertraline) 100mg and Zaptra 25 (Paroxetine 25mg + Clonazepam 0.5mg) is a relatively better option.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 12 hours later
sir

thanks for your opinion but sir as i mentioned in the first option daxid 50 and recitaforte used by me for last 45 days i am having a trembling effect in my hands which is a childhood problem but it has enanched now.

if sir i continue with daxid 50 and recita forte in night is there any issue or according to you a higher dose of daxid is needed.

sir one more thing if daxid 50 is consumed shall it take a longer time for recovery and if daxid 100 is consumed the recovery will be faster is it only the issue or any thing else.

sir daxid is good or fluvoxine is better suggest
doctor
Answered by Dr. Jonas Sundarakumar 36 hours later
Brief Answer:
100mg Daxid will provide better & quicker results

Detailed Answer:
Hi,

It is common to have an increase in tremors after starting SSRI medication like Daxid. But this is usually only a temporary effect which will gradually subside within a few weeks as your body gets accustomed to the medication. So, you don't have to worry much about this.

Regarding the dosage of Daxid, in persons with OCD, a higher dose is generally required in order to achieve better results. So, my opinion is that it is better to go in for the second option of increasing the Daxid to 100mg as you are likely to get quicker relief. I would suggest that you do the increase slowly in order to minimize the side effects - that is, you can first increase it to 75mg and then after 2 weeks, you can increase it to 100mg.

Fluvoxamine may be a slightly better than Daxid for OCD, in terms of quicker relief, but the side effects and drug interactions are relatively more with Fluvoxamine. So, I would suggest that you stick to Daxid.

Regards,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 12 hours later
sir this time i consulted a Doc of psychiatrist in XXXXXXX who has digonised me with hypocondlia and ocd and advised me daxid 75 and betacap tr 40 may be for tremours,
i am now totally confused what to be prescribed for myself as my existing psychiatrist says not to enhance daxid from 50mg due to tremour.

could u guide me is my case a OCD OR HYPOCONDLIA.

can it be cured by this prescribed drugs or it is not cureable at all.
sir plz go through my history given by me and suggest me.

my compulsive act even makes me to get in to the details of drugs and disease and i use to check on the net for all such stuff like OCD,HYPOCONDLIA,BEST PSYCHIATRIST and also visit different psychiatrist.
doctor
Answered by Dr. Jonas Sundarakumar 23 hours later
Brief Answer:
Diagnosis is OCD and Hypochondiasis

Detailed Answer:
Hi,

Your diagnosis of OCD seems to be clear. In addition, considering the fact that you seem to be excessively anxiuos and worried about your health and you spend a great deal of time in finding out about your health problems, drugs and doctors, I am of the opinion that you are suffering from a health anxiety disorder, also known as Hypochondriasis.

Regarding the treatment of OCD, as I had mentioned earlier, it is with SSRI drugs like Daxid. The exact dosage and response varies from person to person and different doctors can have slightly different opinions on this. But on the whole, all the three psychiatrists feel that you need an SSRI, like Daxid. The minor differences in their opinion about the dosage, i.e. whethet it is 50mg or 75mg or 100mg doesn't make a big difference. So, I would advise you not to get worried about this and to stick to one doctor's prescription and follow-up with the same doctor regularly.

OCD responds well to SSRI medication, but for health anxiety or Hypochondriasis, the main form of treatment is psychological therapy or counselling.

So, I would advise you not to spend more time in trying to analyze about your diagnosis or details about diseases or medication. Such behaviour will only increase your anxiety and mental tension. Rather, try to focus your mind on productive activities. Keep yourself always engaged. Do regular physical exercises and relaxation techniques like deep breathing, yoga, meditation, etc. Go for regular follow-up and counselling with ONE psychiatrist. If you follow these suggestions, I'm sure you will see gradual improvement.

Best wishes,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Jonas Sundarakumar 4 hours later
Thanks for your suggestion i will surely follow your advice but i am having a phobia that if i walk i will lose weight and then again all negative stuff will start disturbing me.

there is no scope of cbt bcoz there are no good clinical psychitrist in my location where i can go for councelling so suggest me some way out on this.

now i will stick to one doc and will continue with daxid 50 in morning and recita forte in night.

my existing doc has suggested me for olanzepene 1.25 mg is it needed sir?

is there any difference in consuming 1500 mg daxid in 15 days as 100 mg per day or 50 mg per day for 30 days,will the result be the same.
doctor
Answered by Dr. Jonas Sundarakumar 17 hours later
Brief Answer:
Doubts clarified...

Detailed Answer:
Hi,

This fear that you would lose weight if you walk is likely to be due to your excessive health anxiety. Like you said, CBT (Cognitive Behaviour Therapy) is the best and most effective for of treatment to treat this problem and reduce such negative thoughts. But in case you don't have access to a psychiatrist or psychologist who does CBT, then you can try online self-help courses or online CBT programmes. I would suggest that you check the following resources for further information:

http://www.cci.health.wa.gov.au/resources/infopax.cfm?Info_ID=53

http://www.getselfhelp.co.uk/cbtstep1.htm

Book: Overcoming Health Anxiety - by XXXXXXX Veale

Regarding Olanzapine - it is an anti-psychotic medication which is sometimes used to treat severe Hypochondriasis. In my opinion, you can first try the SSRI medication and psychological therapy and keep Olanzapine as the last resort.

Regarding your question about the dosage of Daxid, there is a difference between consuming 1500 mg Daxid in 15 days as 100 mg per day and 50 mg per day for 30 days. What matters is the doasage per day and not the overall dosage in a month or 15 days.

Best wishes,
Dr. Jonas Sundarakumar MBBS., DPM., MRCPsych.(U.K.)
Consultant Psychiatrist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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