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Can my OCD get cured with lower dose of medicine?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Nidhi Jain

Medically reviewed by

iCliniq medical review team

Published At March 19, 2016
Reviewed AtSeptember 4, 2023

Patient's Query

Hi doctor,

I have a brain lesion in the left temporal lobe size 0.9 mm as found in brain MRI. I had a seizure twice two years ago. I am also suffering from OCD. Fluoxetine 40 mg has been very effective in treating OCD but caused memory problems, speech problems, and lack of concentration. When can I lower my dose? Can I cure my OCD with a lower dose? I am medicine compliant and after trying several SSRIs, found Fluoxetine effective in lowering obsessions, intruding thoughts, and compulsiveness. After enjoying two years of feeling well, I suddenly found myself plagued by recurring, distressing thoughts centered on concerns about safety or potential catastrophes that could harm my reputation in society. This brought about anxiety, and despite my best efforts, I was unable to quell these persistent thoughts. I have been diagnosed to have OCD six years back. While I previously experienced recurring thoughts of insecurity and intrusive fears of mishaps, I found myself compelled to pray extensively in hopes of obtaining reassurance that nothing would go wrong. I took Sertraline 200 mg as prescribed by the psychiatrist and Petril-MD 0.5 mg as needed but stopped taking them because of intolerable side effects. I did not take medicines in the past to cure this illness. Please help.

Answered by Dr. Nidhi Jain

Hi,

Welcome to icliniq.com.

For Obsessive compulsive disorder (OCD) you have to take medications. Less than 40 mg Fluoxetine will not be effective. So, continue the same dose. chances of relapse are very high in OCD cases. As you are having it for six years it is better to continue the medication. Take multivitamin and Tetrafol 1 (Folic acid) along with it to improve cognition. May I know, till now how many episodes you had? Thank you.

Patient's Query

Hi doctor,

I had several episodes of OCD. The first one when I was in ninth standard. I had a fear of having diabetes because I was habitual of eating sweets and sugary items a lot. I stuck to the thought that I should have a blood sugar test done to get it treated. My doubt got cleared when my urine test for sugar was negative. When I was in 12th class I had a fear of getting fail in my board exams. Though I was above average student and used to secure 70 to 80 percentage marks the fear of getting fail used to come in my mind again and again. I was not able to study. With the age my OCD developed serious fears and caused panic attacks which rendered me embarrassed in triggering situations. There have been several fears that have triggered OCD. When I was in the first year of college, it was a great change in life. I got seriously depressed and was not able to adapt in college life after my school. Thoughts of getting raped used to make me anxious. Though up to school life no such thoughts ever disturbed me. Triggerer was the news of rape in newspapers and television. I avoided reading newspaper and used to hide newspaper in cupboard so that I can avoid getting triggered. It is only six years back when I came to know what used to happen to me was OCD a mental illness. I want to know whether it is because of my temporal lobe lesion or it is genetic? My mother is suffering from schizophrenia and is on 1 mg Risperidone.

Answered by Dr. Nidhi Jain

Hi,

Welcome back to icliniq.com.

You are having history of many OCD episodes, in which fear of getting harm was a prominent symptom. There are many causes of OCD like genetic (particular genes), stress (traumatic life event), infection (streptococcus), brain abnormality (increase metabolism), etc. In your case both causes are there. Nobody can be sure about one particular cause. So, you should continue medications, to prevent further attack. Thank you.

Patient's Query

Hi doctor,

I have been taking Fluoxetine 40 mg for the past 10 months. Though I have found this medicine effective in controlling my symptoms of intruding thoughts and compulsive behavior (praying and checking), for a few days I have felt OCD triggered in me again. A dreadful thought was repetitively coming in my mind and causing embarrassment and lack of confidence. But, it was a bit milder than I used to have when I was not on medicine. I feel an incident has triggered my OCD. I was in a metro station and went to the toilet to urinate. I saw there was nobody sitting on the counter to take fees. I saw a man cleansing the ladies toilet. I got tensed whether I should go to the next ladies toilet as there was no knot in it. I got out as there were no ladies. There were only men. I came out without urinating and thought what might have happened if I got raped. This thought repetitively came in my mind that day and triggered OCD in me. It has been three days but embarrassing thoughts are coming in my mind in short intervals as what if I am a famous personality and got raped, everyone knows of my getting raped and what if I am a married women and got raped, my husband and in-laws have thrown me out of their house as I am no more a respected person of society who can easily expose her identity. Though being on 40 mg Fluoxetine I am not feeling anxiety, but these thoughts are coming again and again in short intervals. What to do? Should I increase my dose?

Answered by Dr. Nidhi Jain

Hi,

Welcome back to icliniq.com.

Do not worry. Nothing bad will happen. Nobody is going to rape you. It is only symptom of OCD and not reality. Everything is going on in same way. Only your mind is having repeated intrusive, uncontrollable, distressing thoughts. Just relax. Hike dose of Fluoxetine to 60 mg in the morning. Take tablet Clonazepam 0.5 mg one tablet at night for five days, then half tablet at night for five days and then stop. I am hiking your dose considering your symptoms. Please consult your specialist doctor, discuss with him/her and take the medicine with consent. Review after 21 days.

Patient's Query

Hi doctor,

Now, the side effects of Fluoxetine has disappeared. I feel drowzy and tired sometimes. For the past few days, I am feeling depressed and anxiety pertaining to some past life incidents. Is it a side effect of prolong use of medicine? I had my worst OCD episode recently. I recovered to some extent without medicine after changing my work department at that time. Please suggest what should I do to control my anxiety and increase confidence.

Answered by Dr. Nidhi Jain

Hi,

Welcome back to icliniq.com.

What about your sleep? Is it normal, less or more? There are many depressive symptoms such as low mood, loss of concentration, ideas of hopelessness, helplessness, suicide, etc. What are the depressive symptoms do you have? Thank you.

Patient's Query

Hi doctor,

Except suicide, I have all other symptoms like unwillingness, lack of interest and enthusiasm, hopelessness and feeling low. Sometimes, I am not able to enjoy certain tasks which I did earlier. Because of my mental illness, I am afraid to face people. Facing people who laugh at weaknesses of others is a great fear to me. This fear appears to me due to my depression. I know life is a challenge, but for people with mental weakness like me, it is more challenging. I want to overpower my fear, so that they cannot make fun of others and demoralizing them by their stupid comments. I do not think of suicide. The only thing I want to have is supportive and healthy atmosphere.

Answered by Dr. Nidhi Jain

Hi,

Welcome back to icliniq.com.

Actually, OCD is very commonly associated with depression. Fluoxetine is an antidepressant and anti-obsessive medication. Fluoxetine works for both OCD and depression. So, I am hiking the dose of Fluoxetine. Take Fluoxetine 60 mg in the morning. Mindfulness therapy is required for you. You should not feel yourself so weak and anyone can hurt you. You should learn to control on your own emotions. Never be fearful by critical comment of others. You had mental illness, but it has improved. You are not mentally weak. You can be mentally very strong. If you trust on yourself, then you can do it. All the best. Get a review after 21 days. Thank you.

Patient's Query

Hi doctor,

I sleep normal in night and I do not feel insomnia. Following your suggestion, I started taking 60 mg Fluoxetine. It has been three days now. But contrarily I am feeling my OCD symptoms like running thoughts and depression are returning again. I am not feeling drowsy which I used to have while taking 40 mg. So, should I continue 60 mg? I lost my father at the age of 10. My mother has chronic schizophrenia, for which she is having medicines for last 15 years after the death of my father. My elder sister is unmarried and she too has schizophrenia. She is not medicine compliant so I am giving treatment to her by mixing medicine in her food and she is now working well. My brother is working away; therefore the whole responsibility comes on my shoulder. I weep a lot and remember my father if he were alive, I have had a great encouragement. OCD and depression decreases my ability towards my responsibility. These facts make me more depressed. When I was taking 40 mg, I was very confident and happy. Only after any triggering situation I used to feel OCD. What should I do regarding my dose of Fluoxetine? Can you suggest me some cognitive behavior therapy technique?

Answered by Dr. Nidhi Jain

Hi,

Welcome back to icliniq.com.

The onset of action of Fluoxetine is very slow. Fluoxetine 60 mg will start working after at least seven days. And you had taken it only for three days. I know you are having some OCD and depression symptoms. That is why I hiked your dose. So, continue with Fluoxetine 60 mg. Definitely you are having so much stressor in your life and having responsibility of your family. Be strong; you can do it. It is good if you will take cognitive behavioral therapy or CBT for OCD. It is good if you visit a psychologist. Thank you.

Patient's Query

Hi doctor,

I have been taking Fluoxetine 60 mg for two months, following your suggestion. Though I had great relief in my OCD symptoms, today I felt some intrusive thoughts, which are fluctuating like mood swings. In the morning, I saw a song in which a boy and a girl, who love each other got married. After their marriage, one day the girl was raped in a moving car. When I reached my office, the song of the film and the scene of rape came to my mind repeatedly. Sometimes, I was fine and then again the scene was intruding my mind. I felt uneasy and had difficulty in concentrating my work. I felt as if I should leave my office, quit my work and go home. I felt lazy and lack of interest in doing any work. When I reached home and after talking to my sister, I was relaxed to some extent. Actually, my marriage has been fixed. So, before marriage, several things are coming in my mind. How will I continue my medicine after marriage? I am getting obese because of this medicine. How should I control my weight gain? My fiance wants me to get slim. Will I feel comfortable in having physical relationship? If I get pregnant, will this medicine affect my child? If I discontinue the medicine after marriage, then OCD may recur and badly affect my mental health and behavior. Several questions come in my mind and I have once again become sensitive to the things which may trigger my worst fear of rape. Please guide me.

Answered by Dr. Nidhi Jain

Hi,

Welcome back to icliniq.com.

You are having OCD and these are obsessive thoughts recurring in your mind. Actually, OCD course is mostly waxing and waning. At some point of time you are fine and again you will get these symptoms. Wait for a few more days. If you get repeated intrusive thoughts continuously for a few more days (at least for one week), then we will hike the dose further up to Fluoxetine 80 mg. For now, I suggest tablet Clonazepam 0.5 mg one tablet at night for five days and then half a tablet for five days and stop. Consult your specialist doctor, discuss with him or her and take the medicine with consent. You are right. After discontinuation of medicine, OCD may recur and can affect your mental health and behavior. Do not worry about marriage. Get married and continue your medication. Medications will not affect your married life. Have trust on your husband. Discuss with him. Nobody will stop you to take medication. Your sexual life will not get affected. You have to cooperate for it and prepare your mind. Even I hope, after marriage your fear of being raped will improve. As you will get the support of your husband. At the time of pregnancy, I will find out a solution for you. Do not worry now. We have many options and we will discuss later on. Fluoxetine does not cause weight gain. It is known to cause only weight loss.

Patient's Query

Thank you doctor,

Should I have an MRI brain for the lesion present in the left temporal lobe? After taking Fluoxetine I feel a pressure on the left-sided brain. I also can feel some activity on the site where the lesion is present. I feel mood swings. Is it the symptom of OCD or the seizure activity due to the lesion? I had seizures twice two years ago. I stopped taking antiepileptics after taking them for nine months. Then, I never had a seizure, but feel the aura sometimes. Please help.

Answered by Dr. Nidhi Jain

Hi,

Welcome back to icliniq.com.

No problem. You can go for repeat MRI and also get qEEG (quantitative electroencephalography). You had received an incomplete course of antiepileptic, which is only for nine months. Usually it does not happen, feeling lesion after taking medicine. Mood swing may be associated with OCD (secondary depression) or it can occur as an aura or prodromal symptoms. If it is seizure, then you have to start antiepileptic course again. How many times did you have this mood swing? Is it sudden or gradual? How long does it persist? Do you have it suddenly during sleep too? Do you have some other strange feeling? Which antiepileptic did you receive at that time? Do you have any attack of unconsciousness, presently? Thank you.

Patient's Query

Hi doctor,

My mother has chronic schizophrenia. The doctor has added one more medicine Olanzapine to reduce the negative symptoms of schizophrenia. My mother has responded well to it. She feels fine at home and talks to us comfortably. But she hesitates to talk to any relative, shows blunt expressions when we take her out. She shows no interest in talking or answering to any person beside us. These days we took her out to meet a relative and visit some places there. We were all enjoying but she was sitting confused and a bit feared. A child came to her to wish her good morning, she smiled and picked up the child on her lap, but after few minutes, she again showed some blunt expression, paying no attention to the child. It was seeming as if every effort to bring her, in reality, was failing, though she was herself trying to enjoy. She tended to be in an unanswering mode. I was trying her to communicate with others and enjoy the environment, but tended to be in the semiconscious state and wanting to sleep. I want to know why it is happening to her when we try our best possible efforts to distract her to take her out of the semiconscious state of mind. I am suffering from OCD. In severe OCD episodes, I also tend to be in semiconscious state of mind when I want to enjoy the environment but not able to do that. No distraction is able to take me out of that brain-locking mode, when I feel mentally paralyzed. I too become unresponsive to various situations and people talking to me. This forces me to think, that I have OCD because of my mother, and tend to hate her for this, though I love my mom very much and do not want to think so. I feel as if when I reach my mother's age I will react the same way. My mother does not have OCD, she is suffering from schizophrenia. Where from I inherited this disease? My father was a bit compulsive of cleanliness. He hated dirtiness in the house and want the house clean every time. He hated us watching TV for long hours, and playing games and not studying. He wanted us to study subjects. But he never had any psychotic episode. All these habits added to his achievements in his life.

Answered by Dr. Nidhi Jain

Hi,

Welcome back to icliniq.com.

Olanzapine is a good antipsychotic. But remember that it causes weight gain and sedation. So, ask your mother to start regular exercise and dietary control beforehand. For negative symptoms of your mother, she can start tablet Amisulpride 100 half tablet in the morning for five days, then continue 100 mg one tablet in the morning. Also, start Trihexyphenidyl (Pacitane) 2 mg in the morning. Amisulpride is better for negative symptoms and can add it with Olanzapine. You and your mother can take multivitamin one tablet daily. Any person can have this illness OCD, even if no family member or even relative is suffering from the same. So need not to blame your mother.

Patient's Query

Hi doctor,

I am taking 60 mg Fluoxetine to treat my OCD symptoms. Though the medicine has been effective in controlling my intrusive thoughts, I do not want to quit taking medicine. But from a few days, I am feeling very lethargic, tired and mostly like to lay on the bed for long hours. I do not feel active and conscious. These symptoms of lethargy are making me think I should lower my dose and quit the medicine. Also, I do not know, my OCD may recur if I quit fluoxetine. I just want to know if I may be able to cure this feeling of tiredness, lethargy, and laziness in me. I am not feeling active these days and feel dizziness.

Answered by Dr. Nidhi Jain

Hi,

Welcome back to icliniq.com.

Do not stop Fluoxetine. It will cause relapse in your symptoms. Also add one tablet Tetrafol 1 (Methyl folate) one tablet daily. It is a Folic acid supplement. Do you have another symptom like increase or decrease sleep, appetite, persistent low mood, negative thoughts, weakness, etc.?

Patient's Query

Hello doctor,

It has been one year to me taking 60 mg Fluoxetine. The medicine has reduced OCD symptoms. But sometimes when I come to hear that some people in my office have labeled me as 'psycho' and as a girl with a neurological problem, regarding the anxiety I used to have when I was not taking Fluoxetine and was on antiepileptic treatment after seizure episodes, it makes me depressed. It hurts me a lot being labeled psycho. Now when I feel cured of OCD symptoms, these things make me feel worse again. I hesitate to face these people. I feel comfortable when there are a few people in the office. From two days, I feel distracted and concerned as I do not want to be tagged as 'psycho'. I am feeling fine when I am busy, but as I am free this very thought is disturbing me again and again. Recently I have got my brain MRI done which is reading a bilateral basal ganglia calcification. It is not showing ring-enhancing lesion on left temporal lobe which earlier brain MRI done 3 years ago was showing. It is showing few non-specific hypersensitivity in the frontoparietal white matter. Few weeks ago I had severe dizziness and balance problem during walking and moving my head up or down or sitting. The dizziness occurred the whole day in increasing intensity. What may be the cause? What should I do?

Answered by Dr. Nidhi Jain

Hi,

Welcome back to icliniq.com.

Please continue medication. Improve your self-esteem. Nobody can level you, you have to level yourself. Everyone in this world has some physical or mental illness so no need of feeling bad. Regarding your MRI findings and attack of severe dizziness with balance, it would be better if you consult a neurologist and get a proper examination.

Patient's Query

Hi doctor,

It has been 1 year to me continuing Fluoxetine 60 mg for treatment of OCD. I am feeling myself getting a bit impulsive and aggressive in pressure situations. I work in a hospital and there is team work in my lab. I remain dedicated to my duty, but careless and let it be attitude of people make me aggressive and impulsive. I want my work in perfection and on time. But due to some people's lazy and uncooperative attitude towards the work, the target is not met. We the honest workers have to listen for it from our seniors. I get easily irritated, restless, patience-less and agitated. Should I lower Fluoxetine dose to reduce my aggression?

Answered by Dr. Nidhi Jain

Hi,

Welcome back to icliniq.com.

There is no need of decreasing the dose of Fluoxetine. Please continue the same. You can start tablet Zeptol CR 200 mg (Carbamazepine) in morning. It is a mood stabilizer. If you get fever with redness of eyes and body rashes, then stop Zeptol CR.

Patient's Query

Hello doctor,

I have been married for eight months, but my husband's behavior has become a cause of concern. He exhibits narcissistic traits and becomes angry when my sister or brother contacts me. He expects me to prioritize him at all times and discourages any interaction with my parents or family members. Both he and my in-laws have imposed restrictions on my visits to my brother, sisters, and mother. Occasionally, my husband and in-laws subject me to a silent treatment, refusing to communicate with me without explanation. It seems as if they expect me to intuitively understand their grievances and comply with their wishes. I am at a loss as to what I may have done to warrant this treatment. Once, I asked my husband if I could accompany my mother to a doctor's appointment for her health checkup, as I have a background in the medical profession and understand health issues. He responded with anger, implying that I hold no value to him. This led to an argument, during which my mother-in-law blamed me and insisted that I either follow my husband's directives or face divorce, stating that such behavior would not be tolerated. I attempted to communicate my feelings and needs to my husband, hoping for his support. I requested the freedom to assist my brother and sisters with their medical issues by speaking to and visiting them when necessary. In response, my husband and mother-in-law asserted that as their daughter-in-law, my sole focus should be on them, and I should forget my parents if I wish to maintain a happy marriage. They offered me the ultimatum of either conforming to their expectations or returning to my parents and seeking a divorce. Presently, I am residing with my parents, but I still care for my husband. I send messages and call him, but he remains unresponsive. I am devastated by this situation. He is pressuring me to agree to a mutual divorce, but I do not desire to end our marriage and want to salvage our relationship. Regrettably, he is not making any effort to reconcile or communicate with me. I find myself sinking into depression due to these circumstances. Please help.

Answered by Dr. Nidhi Jain

Hello,

Welcome back to icliniq.com.

Are you certain that this is the sole reason your husband is contemplating divorce? It is possible that he is using this issue as a pretext for divorce. If this is the case, it would be advisable to have a thorough and open discussion with your husband. Share your feelings and the extent of your responsibilities towards your parents in detail. If he remains unwilling to agree, you might need to consider creating some distance between yourself and your parents. Additionally, for your depression, I suggest taking one tablet of Nexito (Escitalopram) 10 mg in the morning.

I hope this helps.

Please revert in case of other queries.

Thank you.

Patient's Query

Hello doctor,

Thank you for your reply. Your guidance has been invaluable in managing my OCD symptoms. I have been consistently taking 80mg of fluoxetine for about five months now, up from the previous 60mg dose. I have seen significant improvements in my OCD symptoms, since your last consultation. However, over the past few days, I have been experiencing intrusive thoughts, mental uneasiness, and depression. I recognize these as OCD-related thoughts, but I am struggling to reduce them on my own. This mental discomfort has slowed down my work, and I have lost interest in activities. It feels like a relapse, reminiscent of the symptoms I had before starting medication. Even though I am now on an 80mg dose, I am facing these challenges again. In the past, increasing the Fluoxetine dose has helped alleviate my symptoms. I do practice meditation and yoga, but it seems like medication provides faster and more effective relief. I would appreciate your advice on whether I should consider increasing the Fluoxetine dose once more, as it has worked well for me in the past. Please help.

Answered by Dr. Nidhi Jain

Hello,

Welcome back to icliniq.com.

Please maintain your current dosage of 80 mg of Fluoxetine; there is no need to increase it further. In addition, I suggest you to incorporate the following adjustments to your treatment plan:

  1. Add Clonil (Clomipramine) 25 mg tablet: Start with half a tablet at night for the first four days, then continue with one tablet each night.
  2. Include Divaa (Divalproex sodium) 250 mg tablet at night.
  3. Prioritize daily exercise, as physical activity helps reduce stress.
  4. Continue your daily meditation practice.
  5. Dedicate at least half an hour to your hobbies.
  6. Stay connected with your family and friends.
  7. keep yourself busy.

I hope this helps.

Please revert in case of other queries.

Thank you.

Patient's Query

Hello doctor,

I began taking Clonil 25 mg in addition to Flunil 80 mg. I noticed an improvement in my symptoms after starting this treatment. I have been taking Clonil for three months now. However, over the past two to three days, I have been experiencing uneasiness and a relapse of my OCD symptoms. Should I consider increasing the Clonil dosage? If so, what is the maximum safe dose of Clonil I can take? While the medications have provided relief from my symptoms, I have observed that after a certain period, a relapse occurs, necessitating a dosage adjustment. I am trying to avoid frequent dose increases and hope to achieve symptom reduction with my ongoing treatment. Can you advise me on the number of medications I might need to effectively manage recurring OCD symptoms? I do not have any issues with taking medications, but my goal is to see improvement and symptom reduction without the need for frequent dose changes or increases. Please help.

Answered by Dr. Nidhi Jain

Hello,

Welcome back to icliniq.com.

Please continue with Flunil (Fluoxetine) 80 mg. I suggest starting with one and a half tablets of Clonil (Clomipramine) 25 mg at night for the first week, and after that, switch to Clonil 50 mg at night. Additionally, I suggest you take Divaa (Divalproex sodium) OD 250 mg once daily and tablet Etilaam (Etizolam) 0.5 mg for 15 days, followed by half a tablet for the next 15 days before discontinuing it. Consult your doctor and take the medicines. Avoid excessive changes in your medication regimen. Focus on improving your lifestyle and incorporate stress management techniques. Keep yourself engaged in various activities.

I hope this helps.

Please revert in case of other queries.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Nidhi Jain
Dr. Nidhi Jain

Psychiatry

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