Dr. Ruhi Satija
Psychiatry
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
For someone suffering from anxiety, OCD, intrusive thoughts. This person was on 5 mg of Cipralex for quite a few years, then about eight months began a change of medicines, about six to seven in this time. Finally this person was given 25 mg Fluvoxamine. First four days everything was fine, and then anxiety attacks started. As of last night dose went up to 50 mg. Result is the person is feeling calmer however they feel very disconnected and cannot do anything, cannot concentrate, cannot think or analyze things. I forgot to say that when they started Fuvloxamine they stopped the five drops of Cipralex.
We do not know what to do tonight, whether to stop this Fluvoxamine and go back to Cipralex or whether to keep going and maybe these side effects will stop (if so how long aproximatly). We are very confused and can not contact that prescribed this. Please help.
Hello,
Welcome to icliniq.com.
I can understand your concern. As you have mentioned that the patient is feeling better with this medication, I would suggest you to continue 50 mg Fluvoxamine for at least another two to four days and see if they feel okay. Fluvoxamine has a sedative effect and that is why the patient is feeling all these symptoms of not being able to concentrate or do anything, etc. I would suggest you to take the medicine before sleeping. 50 mg is actually a low dose so you should not be worried. Continue same dose for a few days and see if body adjusts sometimes if anxiety is under control with Fluvoxamine, some medicine can be added to prevent the side effects.
Secondly, you have not mentioned details of the patients age, etc., I would suggest you that if possible, patient should start therapy as well. Medications and therapy when combined give faster results. Take care of yourself.
Patient's Query
Hi doctor,
Thank you for your answer.
You are correct that 50 mg is a low dose. However, this person has a very low tolerance to medication. The medicine was giving him panic attacks and zombie-like reaction. In addition, he had confusion and depersonalization. We finally managed to get his doctor on phone. He has asked to stop it immediately as it was obvious he was not tolerating it.
Thank you.
Hi,
Welcome back to icliniq.com.
I hope he feels better soon. Take care.
Patient's Query
Hi doctor,
I have one more question for you. So he has gone back to his original 5 mg Cipralex because the fluvoxamine was making him like a zombie. He had been taking fluvoxamine for 10 days. With Cipralex 5 mg, he is awake as his old self. However, his intrusive thoughts have increased. My question is could this be a withdrawal symptom from having stopped fluvoxamine? If so, how long will it stay? Is there anything he can do for the increased intrusive thoughts that is not taking benzodiazepines, which are addictive and would only make him sleep? Please help.
Thank you.
Hello,
Glad to have you back!
I am here to help you get the best medical advice.
Yes, you are correct, it is happening because fluvoxamine has been stopped. Cipralex (anti-depressive) should take four to five days to start working. Benzodiazepines are good if you only take them for a few days. It is best to avoid them but, if you feel that the patient is too agitated or irritable, 0.25 mg of Clonazepam works fine.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hi doctor,
Please let me understand better. So you agree that the increased intrusive thoughts are a withdrawal symptom of fluvoxamine? Even though the fluvoxamine was taken for only 10 days, can it still have this effect? I thought that being less than two weeks, it would not have any effect. Please you can explain to me and confirm if this is the case, because, obviously he is very worried that it is the Cipralex that is making things worse. This person has an important designation in his workplace. You suggested Clonazepam (unfortunately, also very addictive), but will that make him zombie-like, sleepy, and unable to function? Is there anything that is not so addictive? I am asking for my son. Please help.
Thank you so much.
Hi,
Glad to have you back!
I am here to help you get the best medical advice.
I am sorry for your son. The intrusive thoughts are the basic issue, they are going to be there when not treated. They were controlled by Fluvoxamine (anti-psychotic)and now that it has been stopped, they have started again. Cipralex (or any antidepressant or antipsychotic for that matter), takes a few days to reach the necessary levels to have an effect on symptoms, which is why the delay. Clonazepam is a short-acting benzodiazepine and a good medication. They are addictive if taken long-term ( for example, if taken daily for a few weeks). However, occasional use to reduce anxiety or agitation does not cause an addiction. It is the best medication for acute management of symptoms.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hi doctor,
Are these questions and answers public?
Thank you.
Hi,
Glad to have you back!I am here to help you get the best medical advice.
No, they are not made public.
Thank you.
Patient's Query
Hi doctor,
We have tried many medicines to treat the intrusive thoughts, but they all turned him into a zombie and he was taking the minimum dosage or lesser, actually usually half of the base dosage, and they still had a very strong effect on him. Either they made him anxious, or they made him sleepy, very sleepy, or they gave him suicidal thoughts. He is very very sensitive to medication. Any suggestions?
Thank you.
Hi,
Once more, thank you for allowing us to be of service to you.
We value the high level of confidence you have in us!
Have you tried cognitive behavioral therapy (CBT)? CBT and medications combined are the gold standard for the treatment of OCD (Obsessive-compulsive disorder). You can find a local therapist or I can take online sessions. Many therapeutic techniques are used to first stop the compulsive behavior, and then work on the intrusive thoughts and release the anxiety associated with them. Medication works on the symptoms, but if you do not work on the thoughts simultaneously, the problem is not resolved completely.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hi doctor,
He has intrusive thoughts or images, but no longer has rituals. He used to have some but never debilitating. He should be starting CBT shortly, but he says that with his thoughts he will not be able to follow it. we are waiting for a referral to a good therapist for CBT. Does CBT help? I am not asking if it will get rid of his thoughts as I know this is not possible, but will it help, and how?
Thank you.
Hi,
Glad to have you back!
I am here to help you get the best medical advice.
CBT helps! I see such cases every day. He must start therapy. Surely if you need me, we can start whenever you are ready We can not predict how much of our thoughts can be stopped. But surely it is possible that he does not get affected by them anymore. I take sessions online and it works.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hi doctor,
Thank you very much for your encouraging words. You are very kind. Do you mean it when you say CBT does not stop the thoughts, but he will not be affected by them, or at least not like they affect him now? Do you really mean that? Please be honest with me as I cannot handle another letdown. Do you have similar patients?
Thank you.
Hi,
Glad to have you back!I am here to help you get the best medical advice.
I do have many patients across the globe.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hi doctor,
Are your therapy patients from one country only or from other countries as well?
Thank you.
Hi,
Glad to have you back!
I am here to help you get the best medical advice.
Yes, I do have patients from other countries as well, and the video sessions too are done online.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hi doctor,
Yes, I understand.
Thank you.
Hi,
Glad to have you back!I am here to help you get the best medical advice.
I have patients from across the globe, who are under therapy for similar conditions.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hi doctor,
It was great talking to you. Do you really mean it when you say CBT does not stop the thoughts but he will not be affected by them, or at least not like they affect him now? You really mean that? Please be honest with me as I can not handle another let down.
Thank you
Hi,
Glad to have you back!
I am here to help you get the best medical advice.
CBT is the technique used to prevent the effects of intrusive thoughts on our behavior. You learn to recognize the unhelpful thoughts and learn how to not react to them or engage with them. I can understand your concern, it is hard to see your child suffer. Please do not worry. It will take time because he has been in this situation for a long time, but it is achievable, provided you find a good therapist.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
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