SSRI and OCD
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Anonymous
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DC has been prescribed an SSRI (fluoxetine) for OCD with the plan to ramp up from the starting dose. The question is how do we know what the right dosage is and if this is the right medication at all. Should we expect to see a gradual decrease in the intrusive thoughts and compulsions with increase in dosage? Or do the compulsions stop suddenly only after a certain dosage?
If one SSRI doesn't work even at a high dosage, does that mean that SSRI may not be the right class of medication and we should suggest trying an alternative such as TCA? |
Anonymous
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Yes, you should see a decrease in intrusive thoughts.
I have mild ocd and Wellbutrin helped even though it’s not an SSRI. My son was briefly on Zoloft which seemed to help his anxiety. |
Anonymous
| Fluoxetine is def the most recognized drug for ocd but it does require higher dosages for ocd than for anxiety or depression. |
Anonymous
My DD has OCD and has taken fluoxetine, sertraline and fluvoxamine. They all helped some but the fluvoxamine has been the best, so if the first one doesn't work, it is worth trying other SSRIs before moving to something like a TCA. All SSRIs typically need to be at the high end of the dosage to work for OCD. And our psychiatrist has said that a good response is about 30% reduction in symptoms which enables them to engage with therapy better. But no med will be the only solution. |
Anonymous
| My kid has been on fluoxetine for a little over a year now for OCD. She first started on 5 mg for a few days, then 10 for a couple weeks , then 20. She was on winter break at the time and when school started back up I could already tell it was starting to work just on the 10 mg but she was only 9. The compulsions just gradually dropped off. If we noticed them starting back up more her dosage would increase. She’s on 60 mg now and very rarely does a compulsion. She never really shared any intrusive thoughts with us but she was young. She is a completely different kid on the medication. |
Anonymous
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OP here. Do we need to try each SSRI until it’s maximum dose to determine whether it is working or not, or are there signs along the way that would indicate its efficacy?
Secondly with each titration up on the dosage do symptoms usually worsen before they get better? |
Anonymous
| Symptoms don’t worsen. You can’t predict which will work best. Don’t try to think too far ahead and don’t try to make your kid anxious about reporting back to you whether it’s working. Just take it day by day. Prozac has the best chance of working. As a young adult I took 100 mg a day, and my late-20s daughter takes 60 now. My elderly mother took 40mg. Note that it can work well for years and then stops, and she will have to switch. I take Buspar to augment the SSRI which helps with anxiety. In the nicest possible way I just want to caution you to not let your anxiety spill to her. |
Anonymous
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FYI, the dose for OCD is higher than that for depression. You might not see anything at first.
She also needs CBT. Is she working with a therapist with experience in ERP? Just an SSRI alone won't solve this. |
Anonymous
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Thanks for the replies above. The psych did mention needing to try up to 80 mg of fluoxetine. Is that a lot for a 12 y/o?
We don't have any family history, so this is all unchartered territory for us. The point about not passing on the anxiety to the child is well taken. I am just trying to educate myself from those who have the lived experience. We are looking for therapists for pediatric OCD, but would appreciate suggestions. |
Anonymous
https://iocdf.org/help/definitions/ |
Anonymous
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From International OCD Foundation:
What are the usual doses for these drugs? High doses are often needed for these drugs to work in most people.* Studies suggest that the following doses may be needed: fluvoxamine (Luvox®) - up to 300 mg/day fluoxetine (Prozac®) - 40-80 mg/day sertraline (Zoloft®) - up to 200 mg/day paroxetine (Paxil®) - 40-60 mg/day citalopram (Celexa®) - up to 40 mg/day* clomipramine (Anafranil®) - up to 250 mg/day escitalopram (Lexapro®) - up to 40 mg/day venlafaxine (Effexor®) - up to 375 mg/day |
Anonymous
| Prozac has worked wonders for my teen. DC titrated up to 50mg and has been stable on this dose for almost a year. You will see the compulsions outwardly decrease as the dose increases and it gives your child much relief. They really suffer when the obsessions and compulsions are hard to control and it is a real relief to them to have them better controlled. They may not go completely away but they can certainly get to a point where they don't interfere in day to day life. |