Q. Is it advisable to give Fluvoxamine to a patient with anxiety and OCD?

Answered by
Dr. Ruhi Satija
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Feb 17, 2020

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 8 months began a change of medicines, about 6-7 in this time. Finally this person was given 25 mg Fluvoxamine. First 4 days everything was fine. 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 analyse things. I forgot to say that when they started Fuvloxamine they stopped the 5 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 aproximately). We are very confused and cannot get hold of the psychiatrist that prescribed this. Please if some doctor there is an expert on these meds and theri side effects that could help us. A lot of these medicines and maybe all give strange and serious side effects that are not listed by the pharma companies.

Dr. Ruhi Satija

Psychiatry
#

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 atleast another 2 to 4 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.


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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 panick attacks and zombie like reaction. Plus confusion and depersonalization. We fianlly managed to get his doctor on cell phone and he said to stop it immediately as it was obvious he was not tolerating it.

Dr. Ruhi Satija

Psychiatry
#

Hi,

Welcome back to icliniq.com.

I hope he feels better soon. Take care.


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Good morning doctor... before my time is up i have one more question for you.. you seem very qualified.
So he has gone back to his original5 mg cipralex because the fluvoxamine was making him zombie like. he had been taking fluvoxamine for 10 days. with the 5mg cipralex 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 the fluvoxamine? If so how long before it goes away. Is there anything he can do for the increased intrusive thoughts that is not taking benzodiazepimes which are addictive and would only make him sleep. thankyou

Dr. Ruhi Satija

Psychiatry
# Hello ,
no problem, I am happy to help.
Yes you are correct , it is happening because fluvoxamine has been stopped .
Cipralex should take 4-5 days to start working .
benzodiazepines are good if you only take for a few days . it is best to avoid them but , if you feel that patient is too agitated or irritable , 0.25 mg of Clonazepam works fine .
let me know if you have any concerns.
take care of yourself.

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Please let me understand better... So you agree that the increased intrusive thoughts are a withdrawl symptom of fluvoxamine? Even though the fluvoxamine was taken for only10 days it can still give this effect? I thought that being less then 2 weeks it would not have any effect. Please if youcan explain to me and confirm if this is the case because obviously he is very worried that it is the cipralex and that it is making things worse. This is a person who has an important work position.
You suggest clonazepam,(unfortunately also very addictive) but will that make him zombie like, you know sleepy and unable to function?
Is there anything that is not so addictive?
thank you so much
If i need to contact with site again is it possible to ask for you specifically. I feel very comfortable with you and your answers.
geraldine

By the way Dr. I am the mother.
;.))

Dr. Ruhi Satija

Psychiatry
# ok , hello , I am sorry about your son ,
I can understand your concern .
yes you can directly contact me next time .
The intrusive thoughts are the basic issue , they are going to be there when not treated. They were controlled by fluvoxamine 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 that's why this is taking time .
Clonazepam is a short acting benzodiazepine and a good Medication. They are addictive if taken long term( eg . if taken daily for a few weeks) but occasional use to reduce anxiety / agitation doesn't cause Addiction.
in fact it's the best medication for acute management of symptoms.
yes because they are primarily sedative Medications , they are going to have a numbing effect .

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Are these questions and answers public?

Dr. Ruhi Satija

Psychiatry
# no they are not

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Ok, very good to know... I was afraid it was. WE have tried with many meds to treat the intrusive thoughts but they all turned him into a zombie and he was taking the minimum dosage or less... 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 (wellbutrin). He obviously is very very sensitive to medication. Any suggestions?

Dr. Ruhi Satija

Psychiatry
# have you tried cognitive behavioral therapy

?

CBT ( COGNITIVE BEHAVIORAL THERAPY) and Medications combined are gold standard for treatment of OCD.

you can find a local therapist or I can take online sessions through icliniq itself.

There are many therapeutic Techniques which are used to first stop the compulsive behavior and then work on the intrusive thoughts and release the anxiety associated with them .
Medications work on the symptoms but if you do not work on the thoughts simultaneously, the problem is not resolved completely

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Dr. Ruhi,,, he has intrsive thoughts/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 referall to a good therapist for CBT
Does CBT really 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?
thankyou

If we have difficulty findind a good therapist I will contact you.. can you give me email or telephone number.

Dr. Ruhi Satija

Psychiatry
# oh yes CBT absolutely helps !
I see such cases on an everyday basis . He must start therapy . Surely if you need me we can start whenever you are ready , no hurry.
We can't predict how much of thoughts can be stopped. But surely it is possible that he doesn't get effected by them anymore.

I have many patients I take sessions online and it works.

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Thank you very much for your encouraging words. 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 cannot handle another let down. thank you You are very kind.

I forgot to ask... are your patients from all over the world or from India where you are located?

Dr. Ruhi Satija

Psychiatry
# yes I do.

no all over the world, the appointment is booked through this app itself.

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I meant, are your therapy patients from india only or from other countries?

Dr. Ruhi Satija

Psychiatry
# and the video session too is done through this app only.

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Yes I understand through this app, I wanted to know if you have patients from all over world of only Indian patients?

Dr. Ruhi Satija

Psychiatry
# I have 2 patients from Canada , 1 from Japan and one from US currently , rest are from india

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Thank you... great talking to you. You did not answer my question . .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 cannot handle another let down. thank you You are very kind.

Dr. Ruhi Satija

Psychiatry
# yes I did answer it before and again telling you , CBT is the Technique we use to prevent the effects of intrusive thoughts on our behavior.
Basically you learn to recognize the unhelpful thoughts and learn how to not react on them or engage with them .

I can understand your concern , it is hard to see your child suffer. please don't 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.

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