OCD and residual anxiety

病患者男 - 23歲

Dear psychiatrists,

I am 23 years old. I have OCD, anxiety and depression and I'm taking the following medications. However my OCD and anxiety are still dysfunctional. I have tried nearly all SSRIs and SNRIs and fluoxetine seems to work best. I also need to take two antipsychotic because taking one only does not help stabilize my mood. I need to take two benzos to reduce my anxiety effectively. I originally took valproate for mood stabilization, but it increased by ALT level so my psychiatrist switched me to lithium. I also know that the dosage of phenergan is high, but I can't sleep well without such a high dose.

1. Fluoxetine 80mg daily
2. Mirtazapine 45mg at bedtime
3. Aripiprazole 25mg 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

Despite being put on so many medications, my OCD and residual anxiety still make me dysfunctional. I am a university student and I am under academic deferment. I have unwanted thoughts of killing myself, such as jumping in front of an oncoming train or from a high place. Recently I developed symptoms of somatic OCD. I can't stop noticing my own breath. I regularly see my psychiatrist, clinical psychologist, counselor and social worker. My psychiatrist said she wouldn't make changes in my medications. What can be done to bring my OCD and residual anxiety under control?

梁婉珊醫生回覆:
28/03/2022

Hello, thank you for your inquiry.

According to the situation you described, I understand that you are now undergoing a very tough situation. You need to keep having faith in treatment, and then gradually find out the tiny differences between the change in symptom profiles. You can discuss with your treating psychiatrist and clinical psychologist whats best for you, and tell them openly what is not working.

It is recommended that you start recording a mood diary, most importantly, record your your symptoms of obsession/ compulsion, the changes in mood, as well as your appetite, physical strength, sleep status, etc. At the same time, you also need to discuss with your attending psychiatrist whether the dosage of the medications need to be adjusted.

In addition, you need to explore on the kind of activities that could make your mood a little calmer when your anxiety symptoms surge. As actually each of us may have different interests and hobbies, some may like cooking /mindfulness exercises, and others may like reading … etc. There are also some very useful resources on the Internet, which you can make use of.

Moreover, you also need to communicate with your current clinical psychologist about psychological breakthroughs, and how to deal with the negative automative thoughts. Sometimes, we could be inspired by the problems that we are facing.

In terms of adjusting the dosage of drugs, a detailed records are necessary, it is also very important for your psychiatrist to decide the most suitable medication for you. I believe that there may be fear that has been bothering you, but many patients get better after the hardest time. The first step now is to have good communication with your attending psychiatrist. And don’t give up on trying different combinations of medicine.

There may be difficulties at different stages of our lives. I am glad to know that you have been trying hard to overcome your symptoms, keep a positive attitude on the treatment issue and I believe that the problems will gradually be resolved.

Get well soon.

Best wishes,
Dr. Leung

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