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Dr. Mark
Dr. Mark, Psychotherapist
Category: Mental Health
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Experience:  Dr. Mark is a PhD in psychology in private practice
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I have pretty sever OCD, but medications seem to make it

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I have pretty sever OCD, but medications seem to make it worse. I take clonopin in with luvox. the clonopin by its self seems to make me feel better, but when I added the luvox my OCD got even worse and have intense tightens in my chest and feel more nervous then usual. And when I took celexa with the clonopin I had the same reaction, but even worse. It gave me severe panic and tightness in my chest. are these symptoms transient? is this just all in m head? whenI take the clonipin by itself I feel much better, but when I mix it with a antidepressant I get these severe panic like symptoms. Doy ou think my body just rejects SSRI's or do you think the combination of the types of medication is causing these side effects? Please Help!

Hi! I believe I can be of help with this issue.

First let me say that I can imagine how difficult and frustrating this situation must be for you. You are clearly distraught and certainly, the anxiety is acute. So I will also at the end of the posting give you a technique you can use on your own as well for when you are in the throes of anxiety or obsessive thoughts.

The pharmacological treatments for OCD today are much better than in the past. And psychiatrists have more experience with the medications' interactions. From your description it certainly sounds as though the number one suspect here is the medications and the SSRI class. You had success with by itself; you then added two different SSRI's and have had negative effects. So this is a logical first thing to consider with your psychiatrist. And this is the first step even if SSRIs are not the culprit here. Because you need to inform him/her of your situation and you need to discuss how to resolve the problem no matter what is eventually identified as the cause of these particular new symptoms.

But no matter what with these symptoms, I'm concerned that you not rely solely on medications. Because the most effective way to deal with OCD and associated anxiety disorders is with a combination of meds and Behavioral Therapy or Cognitive Behavioral Therapy.

I'd like to make sure it's clear that I view the medications as being vitally important tools in the treatment of OCD and anxiety disorders. But it is also important to remember: medications work on SYMPTOMS, not on what's going on with you as a human being. The problem with just focusing on symptoms is that we are human beings, not biological machines. So very often, when a medication treats one symptom, the underlying human condition that causes you depressed emotions pops up some other way and you are continually chasing after symptoms with your doctors. The research has shown (and my experience as a psychologist has certainly shown this) that psychotherapy WITH medications is much more effective than medication alone. Sometimes it can help the person reduce medications. And this is the tradeoff with medications when they are successful: they relieve SYMPTOMS but they relieve them while they are in your system. They don't actually TREAT the disorder. With pharmaceutical "solutions" you are getting relief from symptoms. That can be very important so that the anxiety from the OCD doesn't overwhelm you and they can help relieve the obsessive and compulsive behavior. But if you want to treat the disorder comprehensively, you would need to use both strategies.

Now here is the important part: you can't expect OCD to get better suddenly. It is going to take methodical work and effort on your part to deal with the behavioral changes you are trying to make. So the key in OCD work is to not get frustrated because it is slow going. But to keep working at it with adjusting the meds and finding an experienced psychotherapist and to keep trying and to keep using the techniques. Okay?

You need to find a psychologist or psychotherapist to help you. If your doctor isn't able to refer to anyone, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (they show you a photo of the therapist!) look at the listing and see if they list CBT therapy in their orientations and OCD as one of the areas they work with. This is important: make sure they are experienced with OCD.

You can also become knowledgeable on the disorder yourself. This is important in helping you take charge of your treatment. Here are some books to start with:

Stop Obsessing:? How to Overcome Your Obsessions and Compulsions by Foa and Wilson. Make sure to get the revised edition. Dr. Edna Foa is a renowned expert.

The OCD Workbook by Hyman and Pedrick. The exercises here are excellent.

Brain Lock: Free Yourself from Obsessive Compulsive Behavior by Schwartz. He's purely cognitive in approach and I've had some people really like his approach though some find it a little too vague. See what you think.

Tormenting Thoughts and Secret Rituals by Osborn. Dr. Osborn has OCD. The book is based on his group therapy and the techniques may appeal to you very much.

Now, I want to give you a tool to use for when the obsessing is overwhelming or there is anxiety. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from OCD or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.

I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.

So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?


  1. After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
  2. Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
  3. Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
  4. Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
  5. Continue down your body, repeating the procedure with the following muscle groups:
    • chest
    • abdomen
    • entire right arm
    • right forearm and hand (making a fist)
    • right hand
    • entire left arm
    • left forearm and hand (again, making a fist)
    • left hand
    • buttocks
    • entire right leg
    • lower right leg and foot
    • right foot
    • entire left leg
    • lower left leg and foot
    • left foot
  6. for the shortened version, which includes just four main muscle groups:
    • face
    • neck, shoulders and arms
    • abdomen and chest
    • buttocks, legs and feet

Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.

What You Need:

  • A comfortable place.
  • Some privacy.
  • A few minutes.


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