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Dear Dr. Kaushik, Just following up with our conversaton on

Dear Dr. Kaushik, Just following up...
Dear Dr. Kaushik,
Just following up with our conversaton on 5/8/13. I am now up to 200 mg of Zoloft and about 2.5mg of Klonopin. It has been 6 months that I have been feeling really badly. I am still having OCD thoughts and anxiety about my marriage all day long and I don't know what to to do. I have been very anxious and depressed for 6 months now. I asked my pyschiatrist if a hypnotherapist could help and he said possibly. He gave me a name of a hypnotherapist that I am seeing this Monday. I have never been hypnotized before. Do you think this type of therapy could help me? Also, I know you do not know me but I am a very conscientious, sensitive person who has had anxiety and OCD on and off for several years. I am a college graduate with a good job and have been married now for over 5 years. I have been at my job for the last 19 years. I try to live healthy eatiing good foods, I don't smoke or drink and I exercise. I am close with my family and friends and I try to be a good person to everyone. I just have this disorder that is interferring with my life and my marriage. Since January, I only missed 2 days of work. I am trying so hard to keep functioning. This is the longest setback I had since my accident 18 years ago. The OCD is very intense as well as the anxiety even though I am on 200mg of Zoloft and about 2.5mg of Klonopin daily. I am crying a lot as well. If you could read my previous posts to you prior to this one just to refresh yourself on my condition that would be great. I guess my question is, What should I do next? Should I switch to another SSRI? I tried Lexapro in the past but it raised my potassium levels too high and caused severe dizziness so I cannot take that one. Also, I tried Anafranil in the past but that caused tachycardia. I just do not know what to do? What do I do when I am having intrusive negative thoughts all day? Even distracting myself is not working very well. Any additional help you can provide would be greatly appreciated. Sincerely, Jean
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Answered in 2 hours by:
6/27/2013
Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4,720
Experience: MD Psychiatry
Verified

Greetings !

Welcome to the site.

I am sorry to learn about your struggle with OCD and I empathize with you since OCD is a very stubborn and demanding condition which requires rigorous and at times aggressive approach in treatment.

From my own clinical experience in dealing with OCD I reckon that you need to ask your psychiatrist to add an antipsychotic drug such as Seroquel ( quetiapine ) at dose of 25-50 mg / day or zyprexa ( olanzapine ) at dose of 5-15 mg / day , any one of them to be chosen and start taking it at night as a single dose.

This addition of an antipsychotic agent at low to moderate dose to the current combination of anti depressant and an anti anxiety drugs is a usual and effective practice to overcome OCD which is not being controlled by the former mentioned two drugs.So basically speaking by adding zyprexa or Seroquel at night will give your drug regime the much needed sting to counter your OCD. It shall take 2-3 weeks after addition of the anti psychotic agent to appreciate the improvement in your OCD thoughts as this much time is required for the drug to reach steady state plasma levels so as to provide the desired results against OCD.

As far as use of Hypnotherapy is concerned I will not want to discourage you in seeking it but from my own experience with the clinical use of hypnotherapy for OCD I will say that is has only limited success against it , so your best bet right now that can help your cause is use of a revised drug regime by addition of the above mentioned anti psychotic agent.

I hope this helps.

Wish you all the best.

Please kindly leave a Positive rating if you are satisfied with the answer.

Regards..

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Customer reply replied 4 years ago

Dear Dr. Kaushik,

Thank you for your answer. In all honesty, I am afraid of trying seroquel or zyprexa. I am exhausted from the Klonopin and I have seen a relative of mine on seroquel with Klonopin and he was totally out of it. In the past, whenever, I had severe OCD it was linked with a relationship problem. When I would change the situation, that is, leave the relationship, I would slowly start to recover. I have only been in 3 relationships - one for 6 years that ended when I was hit by the car, one for 3 years that ended because I was becoming anxious about the type of person I was dating and now I have been with my husband for 13 years - 5 of which we have been married. For some reason, my OCD always involves romantic relationships. It almost feels like I am compromising my health when I am in a relationship. I love my husband and we are very compatible but I have a fear now of being married and I am having intrusive OCD thoughts about being married. During my life, whenever I was single, my OCD was under control. However, in the last 5 years of being married, my OCD would act up for about 25% of the year and then would diminish for about 75% of the year. It's all very confusing and complicated. Do you think this problem is"situational"? I know I have an underlying condition and certain "situations" trigger it. Most things in my life have not triggered my OCD and I am 41 years old. I can go outside, work, travel, have friends, etc...All of these things do not trigger my OCD. I do not want to leave my marriage but at the same time I do not want to be on all sorts of drugs either. I know there are side effects to zyprexa and seroquel and it is a difficult decision to make because it involves my own body. Is there any particular SSRI that you think could work instead of the anti-psychotics? Is it possible that my personality type is better off just being single? If you were in my shoes, would you choose to take the drugs or would you try to analyze if marriage is not a good fit for you? Thank you again.

I believe you should for once keep your reservations aside regarding the use of antipsychotic drugs because what did not work for someone else cannot be generalized and applied to all plus you have used a slew of anti depressants which must have developed what is called as cross - tolerance, in simple words meaning decreased response to other anti depressants owing to the excessive use of previous anti depressants. So the addition that I am recommending will complete your drug regime and provide you the much needed relief.

Yes relationships act as a stressor for you and put you on the spot and let the OCD come round and run havoc in your life , so yes relationships are indeed a perpetual stressor and precipitating factor leading up to OCD but staying away from inter-personal liaisons is not the right way to go about it , instead of running away from the problem you got o fight it out and I am offering you tools to do that by suggesting you an addition which has the capacity to provide you the permanent respite that you strive for.

Regards..

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Customer reply replied 4 years ago

Thanks again. ***** have only used Zoloft for 18 years. I tried Lexapro for 2 days but my potassium increased. I tried anafranil for 1 day and I experienced tachycardia. So really I have only used Zoloft. With this being the case, do you still think another SSRI would not work well?

Well you see after a long time of Zoloft use there is a good possibility that other SSRIs do not work as expected because of cross - tolerance that develops in such scenarios where long term use of an anti depressant leads to development of tolerance for other similar drugs.

So still I will like to stick with the Seroquel / zyprexa as an option for your condition.

Regards

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Customer reply replied 4 years ago

I see. Thank you very much for all of your help and your explanations.

Please kindly leave a Positive rating if you are satisfied with the answer.

Take care.

Regards.

Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4,720
Experience: MD Psychiatry
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