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[ 會員#25776 ] Sam

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? Thanks!
Thank you for your inquiry. According to the information, you have been taking many different combinations of medications. For clinical treatment, the most important thing is to create your symptoms profile list, including detailed symptoms, psychological changes after taking the medication... etc., to establish a detailed record of your medication progress so that you know which combination of medications is more effective.

I would recommend trying to simplify your treatment regimen and considering taking out those medications that might not be helping with your clinical symptoms.

Having more psychological exploration is also recommended, it helps to identify those psychological stressors that might be bothering you for quite a time, e.g.: In some of my cases who are quite perfectionistic in personality, which might cause higher level of stress during their school years. You need to be focused on fixing and targeting those issues, stressors, or value systems that might be precipitating factors for your psychiatric symptoms.

It is necessary to discuss with your psychiatrist the usefulness of each medication, which one you think is helpful and which one is not.

I appreciate your ongoing efforts to help yourself on finding solutions, and I've seen some cases that made significant breakthrough after addressing some of the major psychological hurdles. Don't give up on the belief that things will get better.

Regards,
Dr. Leung Yuen Shan
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