Dr. Siva Anoop Yella
Psychiatry
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Patient's Query
Hello doctor,
I have been diagnosed with dissociative disorder not otherwise specified and OCD. I take these medicines:
1) Escitalopram 20 mg.
2) Lamotrigine 100 mg.
3) Clonazepam 2 mg.
4) Amitriptyline 10 mg (for tension-type headache prevention).
I suffer from mental rumination, compulsion on buying medications, nightmares (every night), traits of impulsivity, and depersonalization. I have vivid dreams every night. I do not wake up in the middle of the night with terror. Still, when I wake up in the morning, I tend to obsess with the content of the dreams:
1) Fear of abandonment.
2) Fear of rejection (by my partner, family, or at work).
3) The theme of changing medications every day.
These sensations last the entire day and I overthink that, and I get depersonalized. I want to solve these problems. I want to stop the racing thoughts and impulsivity. I also obsess with sexual dysfunction. I have delayed ejaculation and loss of desire, and I tend to change the medications compulsively to treat this problem. So my OCD is this mental rumination that gets to depersonalization, obsession with sexual issues, and compulsion to buy and change medications every day. I go to a CBT specialized psychologist twice weekly, but these obsessions do not disappear. I need psychiatric support to choose a plan of medications to not do on myself. I tried many medicines that failed, but I still trust pharmacotherapy. Yesterday night I took 10 mg of Amitriptyline for the first time (in the past, I used it, but yesterday it was the first dose). I took Clonazepam 2 mg for four years, Lamotrigine for two years, and Escitalopram for two months without changing the dosages. Please help.
Hello,
Welcome to icliniq.com.
It looks like you have been suffering from resistant OCD (obsessive-compulsive disorder). As you are not finding improvement, I suggest you change medications. You might be needing higher doses of Escitalopram upto 40 mg to 60 mg daily. To change the medicines, I recommend you consult a psychiatrist personally and directly in your place. Hence, consult a psychiatrist to increase the doses and do not do it yourself. Simultaneously, cognitive behavioral therapy would be helpful to you. I hope this helps.
Thank you.
Patient's Query
Thank you doctor,
I fear that increasing Escitalopram dosage will worsen my sexual dysfunction. I consulted all the psychiatrists in my town, but nobody helped me because I had no compliance. Are there antidotes for sexual dysfunction that cannot “contrast” with OCD? What about adding a low-dose antipsychotic instead of increasing the Escitalopram dose? Please help.
Hi,
Welcome to icliniq.com.
There are medications for sexual dysfunction. Antipsychotic medicines can be added. Did your psychiatrist prescribe Fluvoxamine or Clomipramine, or Sertraline anytime before?
Thank you.
Patient's Query
Hello doctor,
Yes, I tried Fluvoxamine, Sertraline and Clomipramine. The only medicine I found effective was Clomipramine (even at 10 mg, but adjunctive to the SSRI) which antipsychotic can be added, and which medications are there for sexual dysfunction? I tried Fluvoxamine till 300 mg/day, but I was numb at 150 mg/day. I had no obsession or compulsions while on Fluvoxamine, but I had had suicide ideas during the titration. Sertraline had no effect (till 200 mg/day). Once I tried Clomipramine antidepressant monotherapy, but at doses above 50 mg/day. I had too many anticholinergic side effects and anorgasmia. I can say that with 10 mg of Clomipramine (adjunctive to the SSRI), I have only delayed ejaculation and mild constipation. Please advise.
Hello,
Welcome back to icliniq.com.
I suggest the use of Risperidone (atypical antipsychotics) could be added as an Antipsychotic adjunctive. It can be used upto 4 mg maximum, but 2 mg would be ideal, or even Aripiprazole upto 5 mg would be good. SSRI (Selective serotonin reuptake inhibitors) medications like Fluoxetine and Clomipramine or Fluvoxamine with Clomipramine will have good results. But monitoring of side effects is essential and should always be done under the supervision of a psychiatrist. One more treatment modality is repetitive transcranial magnetic stimulation ( RTMS). It can be tried in resistant OCD cases. I hope this helps.
Thank you.
Patient's Query
Thank you doctor,
Which medications could be used for sexual dysfunction? Please suggest.
Hello,
Welcome back to icliniq.com.
Firstly it is important to rule out various reasons for sexual dysfunction. I recommend you consult your psychiatrist for a detailed evaluation of your sexual dysfunction.
Thank you.
Patient's Query
Thank you doctor,
According to your experience, memantine could stop my racing thought and compulsion behavior without affecting the sexual function? Please advise.
Hello,
Welcome back to icliniq.com.
Memantine drug (N-methyl-D-aspartate (NMDA) receptor antagonist) is still under research for reducing compulsive behavior. According to my experience have not found much improvement with Memantine. Vitamin E is found to improve sexual dysfunction. Arginine amino acid supplements are also helpful.
Thank you.
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