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Help with first attempt at medication


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I'm going to be seeing a psychiatrist for the first time in a couple weeks. I've had OCD for twenty years and it's finally gotten so bad that I don't see any other options, I've put off medication thinking I could handle things, but I just can't.

Here in the states CBT is covered by very few insurance policies and most often is out of pocket. I simply can't afford it at this point. Self help is not working. This is my last option.

I've put it off because I'm scared of the side effects and I'm scared (perhaps because I find it hard to get info about the effects of medicine on OCD) that it will cause me to be...not me...if that makes sense. I find a twisted sort of comfort in the way I'm more "aware" of things because of my OCD, but I can't take the pain anymore. I'm just worried if medicine could affect me to the point where I'm "numb" to things even a normal person should pay attention to.

I know you can't give me any specifics because medicine affects everyone different, but I'm wondering if there are certain things I should know before my appt? Questions to ask? What to expect once I start any medicine? Any help is appreciated, this is new territory for me.

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Depends on the medication but I think most SSRI's seem to increase the anxiety for a lot of people during the first few weeks of taking it - but I'm not a doctor I'm only speaking from experience, you might have it differently so what I say isn't gospel.. 

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45 minutes ago, mdlbrightchild said:

What to expect once I start any medicine?

Not something anybody can answer I am afraid. Some people don't have any problems, others may have lots. I just wrote the following text for our new website, not fun reading though.

Side effects

The good news is, most people will only experience a few mild side effects when taking SSRIs. These can be troublesome at first, but they’ll generally improve with time, usually within one or two weeks. Common side effects of SSRIs can include:

feeling agitated, shaky or anxious

feeling or being sick

mild dizziness and/or headaches

tired, weak and/or sleepy

unable to sleep

diarrhoea or constipation

dry mouth

unusual dreams

lack of concentration

Constant yawning

increase in mouth salivia

sweating

blurred vision

low sex drive

difficulty achieving orgasm during sex or masturbation

in men, difficulty obtaining or maintaining an erection (erectile dysfunction)

It may be worth staying in touch with your doctor when you first start taking medication to discuss how well the medication is working. You should also make an urgent appointment to consult a doctor at any point if you experience any significant troublesome or persistent side effects that last more than a few of days.

 

Serious side effects

Thankfully severe side effects rarely happens, but some people may have serious side effects when taking SSRI’s.  If that happens you must contact a doctor straight away if you get any of the following or others not listed:

trouble focusing, memory problems, not thinking clearly, weakness, seizures, or losing your balance – these can be signs of low sodium levels

thoughts about harming yourself or ending your life

chest pain or pressure, or shortness of breath

severe dizziness or passing out

yellow skin or eyes – this can be a sign of liver problems

fits, feelings of euphoria, excessive enthusiasm or excitement, or a feeling of restlessness that means you can’t sit or stand still

putting on or losing weight without trying to

hair l0ss

changes in your periods such as heavy bleeding, spotting, or bleeding between periods

painful erections that last longer than 4 hours – this may happen even when you are not having sex

a high temperature with agitation, confusion, trembling and twitching

Or, if you get any signs of abnormal bleeding including:

vomiting blood or dark vomit, coughing up blood, blood in your pee, black or red poo – these can be signs of bleeding from the gut

bleeding from the gums or bruises that appear without a reason or that get bigger

any bleeding that is very bad or that you cannot stop

Or, allergic reactions including:

getting a skin rash that may include itchy, red, swollen, blistered or peeling skin

wheezing

tightness in the chest or throat

having trouble breathing or talking

swelling of the mouth, face, lips, tongue, or throat

NICE advise close and regular monitoring after starting an SSRI, and more frequently and closely in certain groups such as younger people.  Family members should be asked to keep a close eye on young people taking medication, particularly for signs of depression, thoughts about suicide or self-harm, irritability, aggressiveness, mood changes or other unusual changes in behaviour following the medication.

This is not a conclusive list, so should you experience any of these side effects, or others which become troublesome, it is important that you speak to your prescribing doctor. As mentioned above, despite this seemingly comprehensive list it does not mean you will have any of those problems at all, and if you do side-effects may well be short lived.

 

Dealing with Side-Effects

If you experience any of the above you must consult a doctor, but you might be able to reduce the chance of having some of the side effects if you take SSRI’s in the evening if your doctor says you can, this means you’re asleep when the level of medicine in your body is highest.  There are also a couple of other things which might help:

feeling sick – try taking the SSRI with or after food (perhaps nothing too rich or spicy!)

being unable to sleep – take SSRI first thing in the morning if the doctor says you can.

diarrhoea – drink plenty of water or other fluids in small, frequent sips. Don’t take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or doctor first.

dry mouth – try chewing sugar-free gum or sugar-free sweets.

headaches – make sure you rest and drink plenty of fluids. Don’t drink too much alcohol.

constipation – eat more high-fibre foods such as fresh fruit and vegetables and cereals, and drink plenty of water. Try to exercise more regularly, for example, by going for a daily walk.

 

 

 

47 minutes ago, mdlbrightchild said:

Here in the states CBT is covered by very few insurance policies and most often is out of pocket. I simply can't afford it at this point. Self help is not working. This is my last option.

It's sad to read you feel this is your last choice. In really shouldn't be the case and makes me realise how lucky we are here.

 

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If an SSRI works as advertized, you will be a different person. You will be who you are without the crushing anxiety. 

Is there a possibility that you can be numbed out? Yes, though a low probability and usually that happens more with antipsychotics some people take along with an SSRI.

Going on an SSRI, changes are subtle and occur over time. You have to give them time to work. Most side effects dissipate in short order. If you experience a huge change and it distresses you, go see your psych. Things probably need to be tweaked or a new med prescribed.

This is not your last resort. Meds aren't going to cure you. You will still have OCD. You've been around long enough to know the basics but you likely haven't been applying CBT properly. We'll help where we can.

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Thanks for the information, it's nice to be a little prepared. I've tried to do CBT and I always do fine for a few days and then a major trigger comes and I can't control it any longer. It would be great if meds can somewhat control the anxiety that's become so disabling and I can finally breathe enough and be able to do the actual work to get better.

As it is, trying to treat my decades long, progressively worsening OCD by myself with no relief is about as impossible as it sounds. I guess that's why I feel this is my last resort...

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I've been on medication for a long time.

My advice would be:

Just pop the medication and forget about it. Don't attach any importance to it, just let it work it's magic.

And if you meet unwanted side effects along the way, you can always chop and change medication with your psychiatrist so you find what works best for you. But in general I'd say:

 

Just pop and forget. (a nice little motto!)

Good luck!

Andrew

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