OCD med question

[Labman]

My psych nurse practioner put me on .5 mg of Lexapro two weeks ago. I also started on .25 mg of Anafranil one week ago. I quit the Lexapro yesterday as I thought it was making my anxiety worse.

My problem(s) are twofold. The ativan at .5mg as needed, is not wiping out the anxiety completely. Would Klonopin be a better choice, since my anxiety is usually much worse in the mornings?

Second, to deal with the intrusive thoughts she mentioned a low dose of Risperdal at our last meeting. However, I have a bit of med phobia and was curious if just bumping up the Anafranil to 50mg would work just as well. If Risperdal is the way to go, would there be any problems with starting it now while I'm at 25mg of Anafranil?

Thanks for any suggestions!

 

[Retired]

Ethically and legally we cannot make recommendations for your medications, because only your physician who has your medical history along with an understanding of your diagnosis can competently make such recommedations.

Did you discontinue the Lexapro after consulting your prescriber? Have you had a conversation with your prescriber to explain that you feel the dose of 0.5 mg Ativan (lorazepam) does not provide adequate relief of your anxiety symptoms? Perhaps a dose modification might be in order, if it is appropriate for you.

 

[Labman]

Yes, I am going to talk with her tomorrow. She was aware that I may discontinue the Lexapro. I'm sorry I didn't mean to ask for recommendations, just some ideas in general. My main curiousity was the benefit, if any in general, of people upping their Anafranil dose vs starting on Risperdal. Thanks for the feedback.

 

[David Baxter PhD]

Some patients do feel a bit jittery on Lexapro. Based on my experience with my clients, you might want to talk to your doctor about trying Luvox (fluvoxamine) or Zoloft (sertraline) since these tend to be better antiobsessionals. Another alternative is Prozac (fluoxetine) but that sometimes makes patients with anxiety feel jittery too.

 

[Labman]

I tried Zoloft about 5 years ago and it worked really well. I also took Klonopin at the time. About two months ago when my OCD flared up I tried Zoloft again, starting at 25 mg, but had a lot of additional anxiety at 50mg. I may have pushed things by moving up from 25 to 50 within a week rather than waiting two weeks. I then backed down to 25 for two weeks and notice no beneficial effects. That is when I decided to try the Lexapro. I'd really love to be on Zoloft my life was great on it five years ago. Could it be possible now that I have been off Zoloft two weeks that it may work if I take it slowly on upping the dosage? Wow, there are too many potential avenues when dealing with these meds. Thanks for the all help, I could really use some good ideas right now to discuss with my NP tomorrow.

Also, I have had Zoloft and Anafranil combined, work as well, if that helps any. My OCD seems to flare up about every five years and the above is how my old psychiatrist addressed it on the last occasion. He was a great PD but unfortunately died a few years ago.