Q. How can someone recover from relapsing OCD symptoms despite taking medicines and therapy?

Hello,

Welcome to icliniq.com.

I understand your concern. OCD (obsessive-compulsive disorder) symptoms can appear to be stronger when you feel stressed and work hard. But it can be effectively managed by appropriate medication, following CBT (cognitive behavioral therapy) strategies, and relaxation techniques. Have you taken CBT before? Please describe the medications you are taking. For how long have you been taking these medicines? What is the dosage of these medicines? Usually, SSRIs (selective serotonin reuptake inhibitors) and similar medication is used to resolve the disorder. Are you taking SSRIs? Try to manage stress by practicing deep breathing techniques and progressive muscle relaxation daily for 20 to 30 minutes. After OCD is under control, you may still have perfectionistic traits, which can actually be helpful in your career. I hope this helps. You can contact us if any further advice is needed.

Hello,

Welcome back to icliniq.com.

I had a look at your prescription (attachment deleted to protect the patient's identity). You have been prescribed effective medication to manage OCD but you are still not getting any relief. Is the problem in your studies due to OCD thoughts or are you feeling tired & not able to concentrate? You are already on a maximum dose of Fluoxetine (SSRI type of medications) which is 80 milligrams day Without complete resolution of OCD symptoms, you have started on Modafinil and Desvenlafaxine by your psychiatrist about 2 months ago. Modafinil will help you with wakefulness. Desvenlafaxine is an SNRI (serotonin and norepinephrine reuptake inhibitors) type of medication that is used as a second-line medication in OCD if Fluoxetine is not very effective. You are already on a good and effective dose of Desvenlafaxine. You need to give a few more weeks to see the maximum benefit from the medication. Are you experiencing any side effects like an increase in anxiety or agitation following medication? In that case, discuss with your prescribing doctor so that the dose can be optimized.

You need to have regular follow-up appointments with your psychiatrist to monitor your response and any potential side effects. Do not make any changes to your medication dosage without consulting your psychiatrist. There are some alternative SSRI medications like Sertraline but it has a similar profile to Fluoxetine. If there is no improvement even after a few months, you can discuss with your psychiatrist whether Sertraline can be considered instead of Fluoxetine. Some people with OCD respond better to Sertraline than Fluoxetine though both are SSRIs. More important is to look at non-medication strategies like CBT which is equally important and effective in managing OCD. You mentioned having CBT before, can you revisit the strategies you learned, and can you apply them in your daily life? Also try relaxation techniques along with yoga, and meditation. Stress makes OCD worse and learning to control stress will help with OCD management. In addition to medications, you also need to follow these strategies for cumulative benefit. It may take time but it will be worthwhile. Vitamin D supplements are good as well.

Finally, remember that you will eventually become stronger than OCD by practicing these healthy exercises. OCD can wax and wane during the course of your life. Do not pressurize yourself too much for your studies. Take time for relaxation and fun activities like exercise, music, and meeting with family and friends. I hope this helps. You can contact me again for any further clarification.

Hello.

Welcome back to icliniq.com

You have mentioned that your main problem with OCD at present is compulsive behavior like repeated counting or watching any pattern which disturbs your focus and concentration. It is positive that you are trying to apply ERP (exposure and response prevention) which is the right way forward to break this compulsive ritual. As you know ERP makes you face your worst fears and can be difficult to practice. ERP can appear to increase your anxiety and make you agitated initially but with more prolonged exposure you will get desensitized. ERP should ideally be a lifelong goal to break the cycle of OCD and prevent any relapse. You can consider having some further sessions with your therapist or psychologist to guide you and fine-tune your ERP practice. It will be worth it and make you stronger than OCD. Check out if there is a skilled therapist near your area who can guide you. Discuss with your psychiatrist who may be aware of therapists available locally.

Regarding medications, it is not like you have developed any resistance to Fluoxetine. Many people have relapse of OCD symptoms after the medication is stopped. CBT or ERP helps with relapse prevention. I have noted that you have been started on new additional medications Modafinil and Desvenlafaxine for 2 to 3 months and the dose increased recently. I will suggest waiting for a few more weeks to see whether the changes help. Then during your next review with your psychiatrist, I suggest you can discuss considering Sertraline instead of Fluoxetine. Any changes need to be done under careful monitoring and medical supervision. I hope this helps. Recovery from OCD can be frustrating at times but try to always remember that you will become stronger than OCD with support.

Take care.

Hello,

Welcome back to icliniq.com.

Your psychiatrist is right. OCD tends to fluctuate in severity. The overall trajectory is important. It is positive to note that you felt better for about a week earlier this month. We can expect gradual improvement with continued medications and therapy. Try not to get too worried if symptoms appear stronger on some days. It will pass. You can try mindfulness techniques. Learn to observe your thought process in a detached manner. It will help to minimize the distress associated with intrusive obsessional thoughts and make you stronger than OCD. You can take Vitamin D supplements for another 1 to 2 months and then stop it. You are on the right course of treatment. Continue with medication, continue ERP, exercise regularly, and practice mindfulness. Eat different varieties of fresh fruits and vegetables regularly. There is no other special food indicated. There is no indication of any other add-on medication at present. Make sure to have regular relaxation activities as part of your daily life. Even if you are busy with your exam preparations, make time to listen to music, and chat with family and friends for at least a few minutes daily.

Best wishes.

Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

Dr. Suresh Kumar G D

Experience: 20 + Yrs

Pediatrics

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