What Meds Work for OCD?

[GoWhiteSox]

Hello all-
I have posted quite a bit on the health anxiety board but this is my first time on the OCD board.

I have been working with a therapist for over 5 months and she feels strongly that i have been struggling with undiagnosed ocd my whole life. i do not disagree with this diagnosis.

im currently being treated for anxiety/depression with therapy, 75 mg venalfaxine, and .25 mg xanax which i've been taking once a day...

the xanax seems to be the only thing that helps my obsessive/intrusive thoughts..i dont want to take the xanax anymore for fear of getting addicted and my p-doc doesnt want me taking it daily either..i am meeting with him on tuesday for adjustment of meds...

i am wondering what success anyone has had with meds specifically for ocd..i am very hopeful and excited about finding one and living a life without constant intrusive and obsessive thoughts, but meds have a way of disappointing me..thanks for any input..

[MyNameIsTerry]

Hi,

The OCD board is lot quieter than the HA one so I'm not sure you will get many replies to this. I don't feel I could help you with this as my success with the two meds I've been on has been good to poor and it's so individual that it can differ for us all.

NICE have made some recommendations for meds:

https://www.nice.org.uk/guidance/cg031/chapter/1-guidance#steps-35-treatment-options-for-people-with-ocd-or-bdd

Current published evidence suggests that SSRIs are effective in treating adults with OCD

1.5.3.8 For adults with OCD, the initial pharmacological treatment should be one of the following SSRIs: fluoxetine, fluvoxamine, paroxetine, sertraline or citalopram

Other drugs

1.5.3.20 The following drugs should not normally be used to treat OCD or BDD without comorbidity:

tricyclic antidepressants other than clomipramine

tricyclic-related antidepressants

serotonin and noradrenaline re-uptake inhibitors (SNRIs), including venlafaxine

monoamine oxidase inhibitors (MAOIs)

anxiolytics (except cautiously for short periods to counter the early activation of SSRIs).

1.5.3.21 Antipsychotics as a monotherapy should not normally be used for treating OCD.

1.5.3.22 Antipsychotics as a monotherapy should not normally be used for treating BDD (including beliefs of delusional intensity).

Clomipramine should be considered in the treatment of adults with OCD or BDD after an adequate trial of at least one SSRI has been ineffective or poorly tolerated, if the patient prefers clomipramine or has had a previous good response to it.

1.5.4.5 For adults with OCD or BDD, if there has been no response to a full trial of at least one SSRI alone, a full trial of combined treatment with CBT (including ERP) and an SSRI, and a full trial of clomipramine alone, the patient should be referred to a multidisciplinary team with specific expertise in the treatment of OCD/BDD for assessment and further treatment planning.

1.5.4.7 Following multidisciplinary review, for adults with OCD if there has been no response to a full trial of at least one SSRI alone, a full trial of combined treatment with CBT (including ERP) and an SSRI, and a full trial of clomipramine alone, the following treatment options should also be considered (note, there is no evidence of the optimal sequence of the options listed below):

additional CBT (including ERP) or cognitive therapy

adding an antipsychotic to an SSRI or clomipramine

combining clomipramine and citalopram.

1.5.4.8 Following multidisciplinary review, for adults with BDD, if there has been no response to a full trial of at least one SSRI alone, a full trial of combined treatment with CBT (including ERP) and an SSRI, and a full trial of clomipramine alone, the following treatment options should also be considered (note, there is no evidence of the optimal sequence of the options listed below):

additional CBT or cognitive therapy by a different multidisciplinary team with expertise in BDD

adding buspirone[4] to an SSRI.

1.5.4.9 For adults with BDD, if there has been no response to treatment, or the patient is not receiving appropriate treatment, more intensive monitoring is needed because the risk of suicide is high in people with BDD.

1.5.4.10 Treatments such as combined antidepressants and antipsychotic augmentation should not be routinely initiated in primary care.

How to use clomipramine in adults

1.5.4.11 For adults with OCD or BDD who are at a significant risk of suicide, healthcare professionals should only prescribe small amounts of clomipramine at a time because of its toxicity in overdose[5]. The patient should be monitored regularly until the risk of suicide has subsided.

1.5.4.12 An electrocardiogram (ECG) should be carried out and a blood pressure measurement taken before prescribing clomipramine for adults with OCD or BDD at significant risk of cardiovascular disease.

1.5.4.13 For adults with OCD or BDD, if there has not been an adequate response to the standard dose of clomipramine, and there are no significant side effects, a gradual increase in dose should be considered in line with the schedule suggested by the Summary of Product Characteristics.

1.5.4.14 For adults with OCD or BDD, treatment with clomipramine should be continued for at least 12 months if it appears to be effective and because there may be further improvement.

1.5.4.15 For adults with OCD or BDD, when discontinuing clomipramine, doses should be reduced gradually in order to minimise potential discontinuation/withdrawal symptoms.

Those are snippets to help you find some information but please make sure you read the sections they are from as they can relate to specific treatment statges.

I think HA is very similiar to OCD as it is very obsession based and they do also have some of the OCD compulsions e.g. checking & scanning their bodies, reassurance seeking, etc so even though responses may be limited on here, perhaps the HA guys can say what they have found has helped and it may apply? Failing that, you could always try the dedicated OCD charity forums such as OCD Action, OCD UK, etc.

[GoWhiteSox]

thanks terry I appreciate the reply..i guess i will find out in 2 days what the doc wants me to do :-)..honestly if the med does 'work' i wonder what life is like not having obsessive thoughts..i would imagine it is better :-)..i hope i find out

[MyNameIsTerry]

Give Mindfulness a try too, this helped get rid of my intrusive thoughts and many of my compulsionss as well as reduced my GAD. The latter will help someone with OCD and I believe HA as I found my obsessions weakened and compulsions were more resistable and I'm not the only person on here with a comorbid condition of GAD & OCD who has mentioned this.

There are free Mindfulness downloads and a free course of MBSR on my thread if you see the link in my signature.