Dr. Vishal Anilkumar Gandhi
Psychiatry
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Patient's Query
Hi doctor,
I am a 28-year-old male with a diagnosis of OCD and dissociative disorder NOS. In the last few months, I became apathetic. I think I am not depressed, but I lost interest in daily activities and hobbies. My main problem is mental rumination. I have been put on Duloxetine 60 mg hs and Mirtazapine 30 mg hs for insomnia. I would like to know if Duloxetine is useful for treating my OCD and depersonalization. I tried another antidepressant, Escitalopram 30 mg per day, and had a very significant improvement in my mental rumination. I have other problems like nightmares that disturb me during the daytime and sexual dysfunction (total lack of libido, erectile dysfunction, and anorgasmia). When on Escitalopram 30 mg per day (together with Mirtazapine 30 mg per day), I had no such sexual side effects. What do you think about the choice of the antidepressant? Are there significant differences between Duloxetine and Escitalopram regarding their sexual side effects in young males? Kindly help me.
Hi,
Welcome to icliniq.com.
I can understand your situation. However, Duloxetine has more sexual side effects than Escitalopram. And Duloxetine is not commonly used for OCD (obsessive-compulsive disorder). You can go with Clomipramine with Escitalopram or Fluoxetine. You should also follow the below lifestyle to deal with your problem. It will help you.
1) You should do exercises daily for 30 to 45 minutes, like going for a walk.
2) You should do meditation for 20 minutes daily, sit at one place in a comfortable position and try to concentrate on your normal breathing, do not stop or force yourself to control your thoughts. Just let it be. It will help you to relax.
3) You should eat healthy home-cooked foods, avoid junk foods.
4) You must drink enough water.
5) You should spend quality time with friends and family daily or do video calls if you live away from your family.
6) You should spend time on creative hobbies like reading good books, writing journals, painting, drawing, learning new skills or language or musical instruments.
7) You should take enough seven to eight hours of sleep daily.
8) You must avoid tobacco or alcohol or any substance abuse.
9) Live your life, do not just spend it.
10) Be bold and confident.
11) You have to push yourself to do your daily activities, even you do not want to do them.
I hope this was helpful.
Patient's Query
Hi doctor,
Thank you.
I just tried Clomipramine, and I found it the best medication for OCD, apart from its sexual side effects, even at low doses. In effect, Escitalopram did not give me any sexual side effects (till 30 mg per day). What are the doses you would suggest for the combination of Escitalopram with Clomipramine? I can tolerate not more than 10 mg of Clomipramine because of anticholinergic side effects (dry mouth and constipation). Kindly give your opinion.
Hi,
Welcome to icliniq.com.
If you have side effects of Clomipramine even on 10 mg, it is better to avoid it. Because you may need up to 75 mg for your OCD, it is better to continue Escitalopram with your Mirtazapine which suits you. In psychiatry, patient satisfaction and improvement are more important than specific medications. If you are stable with Escitalopram, then continue it. I hope this was helpful.
Patient's Query
Hi doctor
Thank you.
I will use only Escitalopram (till 30 mg per day) together with Mirtazapine (30 mg per day).
Hi,
Welcome back to icliniq.com.
Please let me know if you want some help. Take care.
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