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Suggest treatment for generalized anxiety disorder and OCD

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Posted on Mon, 21 Jul 2014
Question: I have a problem... if I have a health concern and then see a doctor and they say I'm fine, for some reason my mind is never put at ease, like I start thinking, "yeah but what if he/she made a mistake?" For example I thought the other day that a repaired hernia might have recurred. I saw my doctor who re-assured me that there is nothing to be concerned about. But I still have doubts and I'm not sure why. I had a long hospital stay and was rather traumatized by it. I suffer from Generalized Anxiety Disorder and OCD. It's like I can't accept that things are healing fine and I shouldn't worry.
What is wrong with me and why can't I leave well enough alone?
doctor
Answered by Dr. Manisha Gopal (3 hours later)
Brief Answer:
reason is your GAD/ OCD and personality type

Detailed Answer:
Hello,
I have read your query carefully and I can understand your concern (or over concerns) about various health issues.
You have a diagnosis of GAD along with OCD- which is the real cause behind all your present health concerns.

You must have been taking some medicine for GAD and OCD but have forgotten to mention them. Usually, under normal circumstances, the excess bodily anxiety and health concerns are also well taken care of by these meds. Sometimes, the symptoms might fluctuate and proper drug balance is needed.

In your case, I think the repeated surgeries and repair procedure and long hospital stay acted as a stressor and lead to relapse of the psychological symptoms ( actually such stressful life events can trigger anxiety in even normal individual). I think that you can go for drug dosage rearrangement and also entre into councelling sessions (under a trained therapist -if possible). These two put together will help you cope up with present condition easily. Therapy helps in bringing clinical response at low drug dosages and even prevent relapse.

Your extra concerns/ health anxiety can also be realted to your personality type. Some people are more health concious compared to others and are sort of perfectionist. These people do well in studies and work but if develop GAD or OCD -have excess concerns and anxiety over trivial issues.
So, please revise your dosage of meds you are taking for GAD and OCD and you will feel a lot better.

Hope the reply is useful.
Please feel free to ask more questions for clarification.

Wish you good health!
Dr. Manisha Gopal
MD Neuropsychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Manisha Gopal (1 hour later)
Thank you so much I appreciate the detailed reply!

Do you think it's possible to get PTSD from such a hospital stay combined with the complex surgical history? I have an appointment with a psychiatrist next week. What are the best meds for this? I've tried Lexapro (20mg/day) in the past with very limited success. I was thinking of asking to change over to Luvox since I hear it's good for OCD, and either Xanax or Ativan to help with acute anxiety symptoms.
doctor
Answered by Dr. Manisha Gopal (23 hours later)
Brief Answer:
Venalafaxine or clomipramine + therapy will help

Detailed Answer:
Hello,
First, a long hospital stay may act as a significant traumatic life event, but something to qualify as a PTSD should be severe enough to pose an immediate threat to ones life: like-surviving an earthquake, or landslide or tornado etc. Most people also have flashbacks of that episode which gave them PTSD.
But it dose not matter if it was a PTSD or a stressor with severe intensity ...when someone is disturbed- we must look into the treatment first.
Your repeated surgeries, hospital admissions and long stay were themselves severe enough to challenge anyone's strength...

secondly, regarding drugs- Luvox is good for OCD as you said, but I think that {keeping in mind your basic tendency to get anxious (along with OCD )} you will benefit more with venalafaxine. It is a very good molecule for OCD and also more effective.
You can take Ativan or etizolam, etc., for acute anxiety attacks. Once the main drug starts to show its good result, these adjuvants will not be needed anymore.

The dosage of venalafaxine ranges from 37.5-225mg in divided daily doses.
You may talk to your doctor about these two options.

### lexapro didn't help much in past -was because the intensity of symptoms were more and some better molecule was required.

Thirdly, the best drug for OCD is clomipramine( till date). The best treatment modality for OCD is -- Exposure and response prevention therapy along with clomipramine. So, in nutshell -> drug + therapy will be best possible solution to treat OCD effectively and permanently.

P.S. clomipramine, though is best drug for OCD but has some side effects. You may try that if it suits you. Consider this option if your doctor offers.

Wish you goodd health.
Dr. Manisha Gopal
MD Neuropsychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Manisha Gopal

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Suggest treatment for generalized anxiety disorder and OCD

Brief Answer: reason is your GAD/ OCD and personality type Detailed Answer: Hello, I have read your query carefully and I can understand your concern (or over concerns) about various health issues. You have a diagnosis of GAD along with OCD- which is the real cause behind all your present health concerns. You must have been taking some medicine for GAD and OCD but have forgotten to mention them. Usually, under normal circumstances, the excess bodily anxiety and health concerns are also well taken care of by these meds. Sometimes, the symptoms might fluctuate and proper drug balance is needed. In your case, I think the repeated surgeries and repair procedure and long hospital stay acted as a stressor and lead to relapse of the psychological symptoms ( actually such stressful life events can trigger anxiety in even normal individual). I think that you can go for drug dosage rearrangement and also entre into councelling sessions (under a trained therapist -if possible). These two put together will help you cope up with present condition easily. Therapy helps in bringing clinical response at low drug dosages and even prevent relapse. Your extra concerns/ health anxiety can also be realted to your personality type. Some people are more health concious compared to others and are sort of perfectionist. These people do well in studies and work but if develop GAD or OCD -have excess concerns and anxiety over trivial issues. So, please revise your dosage of meds you are taking for GAD and OCD and you will feel a lot better. Hope the reply is useful. Please feel free to ask more questions for clarification. Wish you good health! Dr. Manisha Gopal MD Neuropsychiatry