[ 會員#25776 ] Sam
A question about refractory OCD, GAD and MDD
I have MDD, GAD, OCD and ASD. I have tried Zoloft, Lexapro, Prozac, Paxil, clomipramine, Remeron, Cymbalta, Pristiq, Seroquel, Abilify, Zyprexa, Risperdal, lithium, Depakine, Klonopin, Ativan, Xanax, Lexotan, Inderal and Lyrica. Please see my current prescription below:
1. Fluoxetine 80mg daily
2. Mirtazapine 45mg at bedtime
3. Aripiprazole 30mg daily
4. Olanzapine 15mg nocte
5. Clonazepam 0.5mg tds prn
6. Lorazepam 0.5mg tds prn
7. Pregabalin 250mg om and 250mg nocte
8. Valproate sodium CR 200mg nocte
9. Promethazine 100mg nocte prn
10. Lithium carbonate CR 400mg nocte
After trying so many medications, my OCD, anxiety and depression still make me dysfunctional. I can't resume my university studies or leave my home alone. I see my psychiatrist, clinical psychologist, counselor and social worker regularly. My psychiatrist said she would not recommend ECT. I tried rTMS and dTMS but they don't work. Esketamine and MAOIs are not available. What can be done to bring my OCD, anxiety and depression under control?
1. Fluoxetine 80mg daily
2. Mirtazapine 45mg at bedtime
3. Aripiprazole 30mg daily
4. Olanzapine 15mg nocte
5. Clonazepam 0.5mg tds prn
6. Lorazepam 0.5mg tds prn
7. Pregabalin 250mg om and 250mg nocte
8. Valproate sodium CR 200mg nocte
9. Promethazine 100mg nocte prn
10. Lithium carbonate CR 400mg nocte
After trying so many medications, my OCD, anxiety and depression still make me dysfunctional. I can't resume my university studies or leave my home alone. I see my psychiatrist, clinical psychologist, counselor and social worker regularly. My psychiatrist said she would not recommend ECT. I tried rTMS and dTMS but they don't work. Esketamine and MAOIs are not available. What can be done to bring my OCD, anxiety and depression under control?
張逸和醫生回覆:
5/7/2022
5/7/2022
Dear Sam
Thank you for your 3rd Enquiry.
Many other doctors including me have tried their very best to address your concerns. Your case is obviously a case of Refractory Anxiety Disorder +/- secondary Depression. Unfortunately most of the 1st line treatment options including medication and psychological treatment have all been exhausted. MAOI is available in USA but it is not worthy to fly to USA for consultation in view of Covid-19 policy. Esketamine is not indicated for refractory anxiety disorder but indicated in Treatment Refractory Depression.
I think the focus of your treatment plan has to be readjusted at this stage since full remission is quite difficult. The aim is to adjust, to cope positively, to live with the symptoms, to maximize your functioning via various measures, to reduce the disabilities involved, to simplify your drug regimen and to reduce the possible side effects that may impact on your functioning.
This is something you can discuss with your treatment team especially your doctor who lead multi-disciplinary team to achieve this target. Our previous recommendations were to be honest, may not be matching to your needs as we did not have an in depth understanding of your condition without a proper assessment.
Take Care. My best wishes
Dr CHEUNG Yat Wo Eric
Thank you for your 3rd Enquiry.
Many other doctors including me have tried their very best to address your concerns. Your case is obviously a case of Refractory Anxiety Disorder +/- secondary Depression. Unfortunately most of the 1st line treatment options including medication and psychological treatment have all been exhausted. MAOI is available in USA but it is not worthy to fly to USA for consultation in view of Covid-19 policy. Esketamine is not indicated for refractory anxiety disorder but indicated in Treatment Refractory Depression.
I think the focus of your treatment plan has to be readjusted at this stage since full remission is quite difficult. The aim is to adjust, to cope positively, to live with the symptoms, to maximize your functioning via various measures, to reduce the disabilities involved, to simplify your drug regimen and to reduce the possible side effects that may impact on your functioning.
This is something you can discuss with your treatment team especially your doctor who lead multi-disciplinary team to achieve this target. Our previous recommendations were to be honest, may not be matching to your needs as we did not have an in depth understanding of your condition without a proper assessment.
Take Care. My best wishes
Dr CHEUNG Yat Wo Eric
以上資料只供參考，不能作診症用途，
請與家庭醫生查詢並作出適合治療。
如有身體不適請即求診，切勿延誤治療。
若資料有所漏誤，本網及相關資料提供者恕不負責。
請與家庭醫生查詢並作出適合治療。
如有身體不適請即求診，切勿延誤治療。
若資料有所漏誤，本網及相關資料提供者恕不負責。
Chan man chun : 失眠
病患者男 - 20歲 你好 這幾年 我每一晚也很難入睡，睡著了也很容易醒 而且很少先覺得疲倦，會是精神問.......wtu06 : 想知道自己是否患有情緒病
張醫生.你好. 我近期出現心慌.氣短.想暈.感覺自己好似隨時要暈低.四肢酸麻.焦慮.打冷顫.嘔心等症狀........wendy : 患上情緒問題
病患者女 點樣可以分辨到子女研究有無患上情緒問題，如抑鬱症?.......JP : 如何分配時間服用多種精神科藥物
病患者女 - 44歲 我有驚恐症，最近復發，在公眾地方暈倒送入醫院急症室，現在不敢乘公共交通和出外食飯。.......vivi : 思覺失調後抑鬱症狀
病患者女 您好醫生 本人12年前因分手後產生被害感覺，及嚴重失眠，年多不能進睡，診斷為思覺失調，調.......Maggie : 思覺失調和抑鬱病
病患者女 - 44歲 我想問醫思覺失調和抑鬱病是否一樣醫法。還有我食了2個月Deprevix Venla....... 發出提問使用細則
致張逸和醫生 提問
