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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?

何美怡醫生回覆
Dear Sam,

Thank you for your questions. Sorry to hear that you have been suffering from a range of different mental health issues for a period of time and the symptoms have not been well-controlled. Unfortunately I am unable to answer your questions without doing an assessment in view of your long and complicated history. I would recommend that you need to speak with your psychiatrist again regarding your concerns.

Dr. Robyn Ho

林樹強醫生回覆
Maybe you should learn to live with the illness. You can talk to the doctor to consider simplifying your long list of medications to minimize side effects if any (e.g. tailing off those added no benefit one by one). Stay on minimal necessary medication first and then try further refining the regimen carefully. Meanwhile you should learn to cope with the symptoms and strive to maximize your functioning e.g. traveling alone. Then set reasonable targets one by one. Rather than putting all your hope on finding a magic drug or any new treatment which can quickly fix all the problems.

Dr Liem

張逸和醫生回覆
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

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