Prozac

[Black]

Hi guys, I replied to a question on fluoxatine a few days ago where I explained how it gave a little improvement  after 4 weeks, then weeks 4-6 was feeling 90% myself with just one bad day a week with ocd thoughts and anxiety. Well I’ve just hit the 6 week mark on 20mg and the past 3 days have been reacting horribly to thoughts and it’s causing terrible anxiety again and insomnia. I know how I’m meant to deal with thoughts but some of them just seem to penetrate out of nowhere and cause horrible anxiety which I can’t tolerate as a mum of a busy 4year old with no family support. I am starting private therapy on Friday with an ocd specialist. Well I hope he is as good and knowledgeable as he seems as I’m terrified of him doing more harm than good. This will be my first time discussing my ocd and no doubt this huge step is playing on my mind and ocd is trying to up its game, but after 6 weeks on fluoxetine should I expect to feel better than I do? I’m feeling back to square 1 these pst 3 days and have made an appointment with my doctor to discuss and I know she will ask if I want to change meds as she thinks these should work within 4-6 weeks. However she doesn’t know about my ocd and I’ve read in a Harvard journal that it can take 8-12 weeks to take full effect for ocd, so I will be asking to stay on fluoxetine as it’s worked well for me in the past at 20mg. Another doctor also told me it can take longer to work a second time around. So my question is, do you agree that I should give the fluoxetine longer and also should I ask to increase the dose at this stage to the 40mg which is often recommended as the dose for ocd? Or should I give the 20mg another month to kick in before deciding whether I need to increase? Thanks for any insights and advice on this

[PolarBear]

Do not count on SSRIs to specifically reduce the rate or intensity of your obsessions. They do that for some people but usually they reduce the nastiest anxiety and depression associated with OCD.

Having a few anxious days is no reason to change your meds or dose. Typically, OCD requires a bigger dose of an SSRI than for general anxiety. Speak with your doctor.

Regardless whether you take meds or not, recovery from OCD requires a fundamental shift in your thinking and behavior. That is why you are going to see an OCD specialist. That person will teach you why you must change your thinking and behavior and how to do that.

My advice is to stay the course. Speak to your doctor and go to that specialist appointment. In the mean time, be kind to yourself. Relax. Don't take on stress if you can avoid it. 

Edited July 12, 2019 by PolarBear

[Black]

Thanks polar good advice. I’ve been doing bits myself but I’ve realised I need to see a professional now so am taking the plunge. Of course worried he’s going to say i don’t have ocd and all my themes are true blah blah blah but I’m going anyway. Big step for me as it’s been a very secret suffering for me with only my husband knowing. Will update after the appointment.

[Handy]

Those on meds say 8 to 12 weeks just like the Harvard. 

What are your expectations for this medication? 

[Black]

To feel less anxious which I do but when I took it several years ago at the same dose it pretty much irradiated my ocd and anxiety within a couple of months with just self directed therapy assisting it. I guess I’m obsessing over whether it’s going to work as well a second time around but I need to give it more time and remember that it’s ok to still have bad days, and also that this time I will be getting help from an ocd specialist. I think I will give it another few weeks before upping the dose, give the 20mg a bit more time to kick in properly and also get started with the therapy, which will of course cause spikes in anxiety itself. Will see what the GP says next week as well.

[malina]

Hey Black,

I'm not expert on medication, but I think the part where you compare your current recovery to how it went in the past may be holding you back. I think it's going to be a bit different each time. We change, our bodies change, our circumstances change. Maybe your recovery went more smoothly or quickly the first time around, but that is no reason to put a lot of pressure on yourself if it's not going quite so smoothly. Also, memory can play tricks on us. In retrospect, things that we have done in the past may seem much easier to us than they were at the time. I think you just need to accept that this is a process and it will go up and down. But it is great that you are communicating with your GP about the meds and getting ready to see an OCD specialist. Good luck with that!

[Black]

Really wise words Malina. Really valid points, no point in comparing and putting pressure on myself to recover quickly, that’s the perfectionist in me. And yes you’re right, when you look back you don’t remember everything or what real time felt like. Thanks for your response, really helpful

[dksea]

On 13/07/2019 at 04:09, Black said:

However she doesn’t know about my ocd 

Absolutely you should talk to your doctor about your OCD, it will help both you and her to best manage your care. 

For one, OCD generally requires higher dosage levels than depression when treated with SSRIs like Prozac. For another, it will help her understand your concerns, what’s a symptom and what’s a side effect, etc. 

On 13/07/2019 at 04:09, Black said:

Well I’ve just hit the 6 week mark on 20mg and the past 3 days have been reacting horribly to thoughts and it’s causing terrible anxiety again and insomnia.

Possible it’s a side effect of the medication but also possible you are just hitting a rough spot. Unfortunately medication is not a cure for OCD and finding the right level for effective treatment can take time and can change over time. 

On 13/07/2019 at 08:52, Black said:

I guess I’m obsessing over whether it’s going to work as well a second time around but I need to give it more time and remember that it’s ok to still have bad days, and also that this time I will be getting help from an ocd specialist. 

It’s good that you recognize these worries as an obsession. And recognizing the limitations is also good. Worrying won’t help the medicine work, so it’s best to try it, discuss any potential side effects with your doctor as well as how well it is going and raise dosage or change medication based on that. If it works, it works. If it doesn’t, you try something else. Worrying only gets in the way. Do your best to let those obsessive thoughts go. 

[Black]

Thanks dksea. Yes I know in an ideal world I would feel comfortable talking to my GP but she’s not my regular gp. The one I’m signed up with is off sick and even she is new to me. I guess because I don’t even know for sure yet whether I have ocd I want to see what the ocd therapist thinks before taking that step of having it diagnosed or put on my record. I’m seeing the ocd therapist for the first time on Friday so it will be good to get the opinion of someone qualified and experienced in ocd when i speak about it for the first time rather than from a gp who may misunderstand or not have good knowledge of ocd. 

I have been told today I can increase my dose to 30mg or 40mg if I want to in a couple of weeks which solves the problem of ocd normally being treated with a higher than 20mg dose. However I do want to give it 10 weeks (I’m in 6 now) as I’m quite sensitive to meds and 20mg worked well for me last time.

She has prescribed me something for sleep  which I’m hoping will help also.

Thanks for your comments and support 

[Handy]

If you don’t know for sure you have OCD you don’t know what to be prescribed. It could be some other condition requiring another type of med.