Question about medications

[stringbean]

I have now been on Anafranil at the recommended dose by my Dr of 175mg for approx six weeks but i am still having good days but also very bad days with my ocd, is this normal ? also can i expect it to improve more on this dose.

I am a little afraid as i thought this is the drug that would work for me after initial good results.

In the last 15 years i have been on prozac which gave me very bad anxiety and increased ocd when i first took it then worked well but once i stopped and tried to take it again the length of time it took for it to settle and work increased therefore i tried citralopram with the same result.

Eventually went onto cipralex and managed to keep taking it until it worked very well but again the same thing happened as with previous ssris, has anyone else had this happen or am i the odd one?

I really want to feel better and would like to get to the place on my meds that i feel better but now i am thinking it wont happenmg:

 

[David Baxter PhD]

The reality of OCD is that as your general anxiety or stress levels increase the OCD symptoms intensify. That will happen even while you are taking medication that otherwise works well. That's why it's so important to learn symptom management techniques to help you cope with such times. Medication alone cannot do it all.

Apart from that, I really would suggest you talk to your doctor about whether changing the dose is advisable.

 

[stringbean]

Thanks Dr Baxter, what i dont understand is that i havent been in a stressful or anxious situation the obsessions just come out of the blue.

I am trying everything that i have learnt with cbt and the four steps etc but sometimes i wake up and i feel better and have a good day and can manage normally then i wake and have a bad day i still do the same things but its so much harder[

---------- Post added at 01:04 PM ---------- Previous post was at 01:03 PM ----------

also have you heard of mood stabilizers being introduced to medication regimes for ocd?

---------- Post added at 01:06 PM ---------- Previous post was at 01:04 PM ----------

ps do you think after 7 weeks on this dose i have the full benefit of the drug /?

 

[David Baxter PhD]

Thanks Dr Baxter, what i dont understand is that i havent been in a stressful or anxious situation the obsessions just come out of the blue.

It's total load. As Dr. Hans Selye said years ago, total stress includes both positive and negative stress. Or it may be background anxiety that you've had so long it seems normal to you.

I am trying everything that i have learnt with cbt and the four steps etc but sometimes i wake up and i feel better and have a good day and can manage normally then i wake and have a bad day i still do the same things but its so much harder

Are you still in therapy?

also have you heard of mood stabilizers being introduced to medication regimes for ocd?

Sometimes, although there's usually a secondary diagnosis.

ps do you think after 7 weeks on this dose i have the full benefit of the drug?

I'm not sure with Anafranil. Better to ask yourb doctor or pharmacist, or perhaps Dragonfly or Steve will know.

 

[Dragonfly]

stringbean, Sorry to hear that you are still struggling with finding the right medication to help with your symptoms. As you know, I can't really say how this might affect you personally, but here are a couple of things that strike me as I read your post: The max. dose of Anafranil is about 200 mg. Sometimes people will push the dose higher, but that will (theoretically) increase the risk of seizures. In general, being at about 200 mg of Anafranil for 4-6 weeks will give that person the maximum therapeutic benefit of the med. When it comes to OCD, the rule of thumb for treatment success is: 1/3 of the symptoms will go away with the right med and dose; 1/3 of the symptoms will go away with the right therapy approach; and the person then is then left to deal with about 1/3 of the symptoms in a way that isn't specifically biological (meds) or psychological (therapy). So, for you stringbean, it becomes a question of number of bad days - if you have 1-2 bad days per week, it is possible that your meds are optimal and it becomes a challenge to draw on every single coping skill that you have for those days. If you have more than, say, 2 bad days per week, then it is less likely that your meds are optimal.

However stringbean, please don't give up or get discouraged. I think that this is a reflection of how little we know about the illness and therefore how much is still left untreated / unknown. But people are learning stuff every day about how to make things better - hence the importance of staying in touch with both prescribers and therapists.

Please let me / us know how it is going.

 

[stringbean]

thank you so much for your reply, i think i have fallen into the trap of wanting a 100% cure which i realise now isnt possilbe!

i am having two to four bad days and two to four good so think maybe could have some improvements to come? The only thing is now i am worried i am being treated for the wrong thing but have had it confirmed that it isnt anything but ocd.
I am now worried that my good days are mania as i wake up feeling so much better and can do all the things i normally do but without feelling like its hard work. Also when i am suffering from ruminations etc i try to sleep more and shut it out but when i feel good i dont do this as i am happy to relax and read a book or watch something as my mind is clear and stayed up reading once til 3am. Would this be mania? questions questions this is ocd isnt it?

 

[Dragonfly]

thank you so much for your reply, i think i have fallen into the trap of wanting a 100% cure which i realise now isnt possilbe!

stringbean - ocd is a bad illness that, given our current treatment options, comes and goes with severity. As I first said, please do not give up hope.

i am having two to four bad days and two to four good so think maybe could have some improvements to come?

Based on what you have told me / us, it is very reasonable to expect / hope for additional improvements.

I am now worried that my good days are mania as i wake up feeling so much better and can do all the things i normally do but without feelling like its hard work. Also when i am suffering from ruminations etc i try to sleep more and shut it out but when i feel good i dont do this as i am happy to relax and read a book or watch something as my mind is clear and stayed up reading once til 3am. Would this be mania? questions questions this is ocd isnt it?

stringbean - you are far too important for anyone to diagnose you based on some postings on an internet forum. Please make sure that your providers know of your concerns. Maybe ask them to write down their diagnoses so that when / if you become uncertain again, you will have something concrete to look at.