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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10643
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I have depression and OCD. Many years on meds and therapy.

Customer Question

I have depression and OCD. Many years on meds and therapy. Now on too much and nothing seems to be working. Lexapro 10 mg, Serquel 300 mg, Saphris 20 mg, Anafranil 150 mg and Gabipentin 300 mg. I have a good life but I seem to be just going through the motions which makes me sad and kicks in my OCD.
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.

*This website DOES NOT constitute treatment and only provides information and advice in a Q&A format. For treatment (therapy and/or medications) you must go to a licensed professional in your area. Please note that anything said here is not private or confidential, as this is a public forum.

Hello and thank you for using JustAnswer. May I ask, what is your specific mental health question that you would like an answer to in regards ***** ***** situation?

Customer: replied 1 year ago.
What is your opinion on the 5 medications I am taking?
Expert:  Dr. Z replied 1 year ago.

Your medication regimen appears to be good and when we talked about this in May you stated that you felt great on the Saphris, even though that medication is not specific for treating OCD. You can ask your doctor to make some subtle changes to your regimen like switching from Lexapro to Luvox, going back on the Lamictal and discontinuing the Seroquel. Gabapentin is probably more for anxiety than anything so that can continue or you can ask your doctor to switch you to a low dose of a benzodiazepine or switch you to Pregablin or Hydoxyzine which have anti-anxiety properties. Unfortunately this is a trial and error approach so some medications and doses will work and others will not work. Right now your medication regimen appears to be good and not too overly ambitious, but if it is not working for you than I would recommend talking to your doctor about making subtle changes to start to see if this improves your mood and lessens your symptoms.

Customer: replied 1 year ago.
Saphris stopped working. Tried up to 20mg and all it does is make me tired. For the lack of a better word I got a "high" originally on Saphris.
Expert:  Dr. Z replied 1 year ago.

If Saphris stopped working than your doctor should remove it from your regimen. Abilify may be a suitable option to help improve your mood and that has been shown to be effective for treating OCD and Depression when combined with an antidepressant.

Customer: replied 1 year ago.
what concoction are you suggesting among the meds I'm talking and what you would add, (or subtract.).
Expert:  Dr. Z replied 1 year ago.

Your doctor has to make that decision, but from what you stated switching from Saphris to Abilify could be beneficial. Luvox instead of Lexapro is considered more effective for treating OCD. You did not mention why you stopped the Lamictal, but I am assuming it is because it stopped working for you, but you can either go back on the Lamictal at a higher dose or try another mood stabilizer like Depakote or Tegretol. I would recommend making a change one at a time to help determine which medication is really working for you and which ones are not.

Customer: replied 1 year ago.
What about the Anafranil. Is it not necessary with Abilify and Luvox? I never thought Lamictal did anything.
Expert:  Dr. Z replied 1 year ago.

If you did not think Lamictal did anything than you can try another mood stabilizer. Anafranil is usually pretty good for treating OCD, but like I said I would not recommend making dramatic changes right now and instead try to change one medication at a time to see if any improvement occurs than you and your doctor will know you are heading in the right direction in terms of medication changes.

Expert:  Dr. Z replied 1 year ago.

I hope this answers your questions and gives you some guidance on this issue. Please let me know if you have any questions or concerns as I am happy to assist and support you regarding this issue.

*Please do not forget to leave a positive rating at the top of the page so that I can get credit for helping you. Thank you, ***** ***** appreciate it.

Customer: replied 1 year ago.
I've not tried Abilify, but otherwise it seems like I'm just churning the same meds looking for new results. Can we think outside the box?
Expert:  Dr. Z replied 1 year ago.

Thank you for your response. I'm not on my computer right now but I will get back to you within 1-2 hours.

Expert:  Dr. Z replied 1 year ago.

Unfortunately treatment for most psychological disorders is a trial and error approach with different medications in the same class (e.g. different SSRI antidepressants, etc....), so that is why I suggested Abilify and also it has a partial agonist for Dopamine which can increase mood and help you get that "high" like you had with the Saphris. Other options that can be considered would be last resort options for more treatment resistant cases such as NMDA anatogonist which has been shown to lessen OCD symptoms and depressive symptoms very quickly. The use of Transcranial Magnetic Stimulation (TMS) has great success in treating resistant cases of Depression, and recent research shows some possibility in lessening OCD symptoms although more research needs to be done in this area. IV Ketamine is currently being provided at a number of clinics across the country and has shown to lessen depressive symptoms in resistant cases immediately and its NMDA antagonist properties make it an excellent option for reversing OCD symptoms too. These are alternative options that can be considered, but you most likely would have to go to a specialist as most psychiatrists do not perform these procedures.

Customer: replied 1 year ago.
Thanks
Expert:  Dr. Z replied 1 year ago.

You are most welcome. Did you have any other questions or concerns that I can assist you with?

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