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Suggest treatment for depression, anxiety and OCD

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Posted on Mon, 2 Feb 2015
Question: Hi,
My name is XXXX. I have problem with sleeping. I always sleep too much. And i always miss appointments and go to work late everyday. I am dignoised with Depression, anxiety and ocd. I get medication for these. I was wandering if you could help. Thanks. XXXX
doctor
Answered by Dr. Chintan Solanki (4 hours later)
Brief Answer:
Yes I can help, pleae provide more detail

Detailed Answer:
Dear XXXX,

I can understand your concern.
Excessive sleep is one of the symptoms of depression.

It may be also side effect of current medications going on.

You have mentioned that you have depression,anxiety and OCD.

To help you in better manner, I would like to know following things from your side.

Please tell more about symptoms of your illness, its duration and past and current problems.

You personal history in terms of education,family and occupation.

Your medications details of past,how much improvement with medicines and current medicines going on.

Which doctor have you consulted means was he psychiatrist?

Waiting for your reply.

Regards,
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Chintan Solanki (15 hours later)
Dear Dr Solanki,
I am thanking for your response and interest for my concern. You wanted me to provide in-depth detail about my illness and medication. I don’t want to tell you about the whole story but here is summary.
Well my illness started in 1997, when I was 18 years old. I believe it started after mobbing that has occurred towards me during my college years. After this, I went into depression and OCD. First, obvious symptoms were OCD. Like washing my hands many times during day and staying away from people. During those years, I felt psychologically ill. I was staying away from people and not talking to everyone. I was feeling everyone is looking at me and expecting me to do a mistake so they can laugh at me. This has affected my education life a lot. In1998, I went to psychiatrist and OCD and depression was identified. The doctor prescribed me clomipramine (anafranil) 150 mg every night. It did help a bit but it was not the real solution.
I was on and off on clomipramine until I got sick in 2007. That year doctor spotted that I have anxiety disorder and prescribed small dosage of sulpride. In 2010, the sulpride was increased to 200 mg at night. Since then I am getting, clomipramine 150mg and sulpuride 200mg at night.
Here are some symptoms that I am still having with my illness:
•     Sleeping too much
•     I do not have confidence/courage. I plan a lot to do things but don’t have the confidence.
•     I don’t have confidence in me.
•     I am a shy person. I get shy while I am with people.
•     I have a masters but I always feel I incomplete. And believe it’s not enough to find a job.
•      I am in vicious circle. Everyone moves on like gets married, have a kid and move on. But I am stuck same place all the time. I don’t and nothing in life change.
•     I am always alone. I cannot easily find a friend.
•     I am usually thinking negatively.
•     I am recently getting panic attacks during driving my car like my heart is going to stop.
•     I have limited scope. I believe there is little I can do outside world.
These are the some symptoms I have that I can remember.
I have seen many doctors and I believe I am not treated properly or my illness is properly diagnosed. Because I feel 60-70% mentally fit. Beside all these, since 1997, I am oversleeping all the time. I go to bed 12.00 am and wake up at 5pm next day. I can easily sleep 15-16 hours a day. Everyone and I am fed up with this. I have 3 alarms and don’t work.
I have managed to complete my masters in Business Computing in 2010. I am unemployed at the moment. I cannot find a job easily. I miss my appointments
doctor
Answered by Dr. Chintan Solanki (8 hours later)
Brief Answer:
Re-evaluation is needed, Prozac and armodafinil are the options

Detailed Answer:
Dear XXXX,

Thanks for great summary.

It seems that you have been treated with inadequate medicines. As well as there is lack of psychotherapy part in your treatment.Initial symptoms suggest schizo-obsessive. It means with obsessive symptoms some psychotic features were there also. However at present you do not have any psychotic features.


Clomipramine for OCD is a good drug but it causes lot of sedation. Better choice is Prozac(fluoxetine).
Your current symptoms suggest depression with anxiety symptoms. In that case sulpride is not going to be useful. Prozac will work for that also.

If your sleep is too much after prozac or you can not have sufficient alertness with that, armodafinil/modafinil is good option for treatment.

For panic attack initially clonazepam or etizolam can be used.

In depression and OCD ,psychotherapy is very useful and effective. You can ask for the same to your doctor.It can boost your confidence and can gradually help to settle in life.

If you are feeling that your doctor is not able to help you, you should change the doctor and discuss what I mentioned. After re evaluation of your history doctor can change and prescribe new medicines.

Hope you will find this answer helpful.

All the best and wish you good health.
Dr.Chintan Solanki.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Chintan Solanki (15 hours later)
Hi,
Thanks doctor for your response. Your response is helpful. I live in London. And doctors here does not take psychological illnesses seriously. Doctors outside england is better and more understanble. Again Thanks.
I want to mention that i tried prozac for 6 months on its own before. And i did not like it. Maybe its because i just took it by itself. I will tell your diagnose to my doctor and i will see a psychiatrist soon. I wish i could talk more to you by email or something. Again Thanks. I will review you response. See u bye
doctor
Answered by Dr. Chintan Solanki (3 hours later)
Brief Answer:
alternatives of prozac are there, all the best and take care

Detailed Answer:
Dear XXXX,

thanks for feedback.

If prozac is not tolerated by you, other options like sertraline or escitalopram are there.They are with the least side effects.You can discuss more with your doctor about that.


Hope you can consult a good psychiatrist who can evaluate you in better way and help you more.

Wish you healthy life and best of luck.

In future you can contact me directly if you wish with this link:
http://bit.ly/drchintansolanki

take care.

Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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Suggest treatment for depression, anxiety and OCD

Brief Answer: Yes I can help, pleae provide more detail Detailed Answer: Dear XXXX, I can understand your concern. Excessive sleep is one of the symptoms of depression. It may be also side effect of current medications going on. You have mentioned that you have depression,anxiety and OCD. To help you in better manner, I would like to know following things from your side. Please tell more about symptoms of your illness, its duration and past and current problems. You personal history in terms of education,family and occupation. Your medications details of past,how much improvement with medicines and current medicines going on. Which doctor have you consulted means was he psychiatrist? Waiting for your reply. Regards, Dr.Chintan Solanki.