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Dr. Vikas
Dr. Vikas, Psychiatrist
Category: Mental Health
Satisfied Customers: 2229
Experience:  MBBS ; M.D Psychiatry, MS. Health Informatics
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Hello: My 17 yr old Autistic son has severe OCD/rituals...he

Customer Question

My 17 yr old Autistic son has severe OCD/rituals...he is currently taking 1 mg Risperdal 2x day and 30 mg Prozac 1x day. He has been on the Prozac since July and at one point we had him up to 40 mg but it has not helped at all with the OCD's..the Risperdal he has been on for a long time. He becomes quite agitated and physical when my husband and I have to reprimand him or stop him from an OCD...example...eating a snack of cookies just as dinner is placed on the table...or ....drinking down 2 bottles of water one after another..etc. I think you get it. Anyway the neurologist suggested we put him on Nortriptyline 10mg 2x day than after 1 week if hes still having difficulty 20 mg 2x day. Everything I'am researching doesn't say this will help the OCD but depression...what do you think?
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Vikas replied 3 years ago.

Hello Madam,

I agree with you in this. Instead of Nortriptyline, Clomipramine is a much better alternative although both of them are tricyclic antidepressant.

Clomipramine is the first line medicine for treating OCD and those patients who are not responding to Fluoxetine respond well to this medicine.

I would also like to say that for treating OCD symptoms, the dose of Prozac (fluoxetine) is usually kept higher in the range of 40-80 mg per day to notice good improvement in majority of patients.

So you can discuss with his doctor about both the options, either increasing the dose of Prozac to reach the level of 60 mg or a little bit higher OR to try Clomipramine instead of Nortriptyline.

Please feel free to discuss further if you have any other query.

Kind regards

Customer: replied 3 years ago.

He was up to 40 mg of Prozac with no change at all. THis med you are recommending is also for depression...nothing about how it helps OCD.

Expert:  Dr. Vikas replied 3 years ago.

Hello Lisa,

Thanks for your reply. There are 3 first line medicines for treating OCD and they are
Fluoxetine (Prozac), Fluoxetine and Clomipramine although other SSRI antidepressants can also be used such as Paroxetine, Sertraline and Escitalopram.

We personally prefer to use either Fluoxetine or Fluvoxamine (both SSRI antidepressants) as a first choice because SSRI antidepressant are considered to have comparatively less side effects in comparison to older generation TCA antidepressants like Clomipramine.

Prozac is approved for both depression and OCD by US FDA and it has been seen clinically that patients suffering from OCD usually require higher dose in comparison to those suffering from depression.

If you think that Prozac is not useful in his case, Clomipramine can be the next best option in my view instead of Nortriptyline.
Expert:  Dr. Vikas replied 3 years ago.
Hello Lisa,

Do you have any other query to ask?

Kind regards


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