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Medication/Therapy Balance?


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My 20 year old son has been a worrier most of his life. Around 3 months ago we became aware he was struggling with intrusive thoughts, to the extent that he was unable to concentrate on his university studies. With the help of the Mind website, which then lead me here, we came to the conclusion he could be suffering from a form of OCD. We had a terrible few weeks trying to access any help, but to cut a long story short he was prescribed 50mg sertraline, which he was taking for around 3 weeks before he was able to get an appointment to start CBT with a private therapist. It took around 5 weeks for the medication to kick in (initially it either had no affect whatsoever or possibly made him worse..vivid nightmares etc). He was still struggling with intrusive thoughts however the medication improved his concentration to some extent and certainly helped lift his mood. After three weeks of therapy he could see this would also help him (although he struggles with some of the exercises). Around 2 weeks ago he was once again very low and thought he may need an increase in his sertraline. He spoke to the GP who didn't seem too concerned whether he went straight to 100mg or to 75mg first (we're not sure the GP really 'gets' he has OCD, she refers to low mood and anxiety). He opted to increase his dose gradually and try 75mg as an interim measure because of concerns about side effects. He is still having the odd thought that really 'sticks' (his compulsions are mainly all mental ones, and the needing to 'solve' all worries) but seems so much better on the whole. Yesterday he decided to increase to the 100mg, he had a really good day, no worries at all, but woke up this morning feeling terrible. Vivid dreams had him waking up crying in the night, went back to sleep but woke with the thought that everyone hates him, which we have put down to the dosage increase. Just to give you the complete picture he hasn't had a therapy session for over 2 weeks due to the xmas period, and his next appointment is over a week away. Apologies for the long winded post but I'm trying to seek advice on the balance between medication and therapy? Without the medication I am not sure he would deal with the ERP parts of his CBT therapy, at the same time although I want nothing more than for him to be rid of these horrible thoughts, if an increase in medication (assuming the side effects are short term and he can cope with them) removes them completely will the CBT therapy be as beneficial? I really want him to develop tools to help him through life, not just a reliance on medication. I know ultimately the decision is his, but as a young adult he does actively seek guidance, support and advice from us (and he is very much aware that without our help, he would probably still be struggling, with no understanding of his condition...he genuinely thought he was a very bad person! I'm so relieved and thankful he feels able to talk to us). As you may have gathered, I have had my own mental health issues over the years and have experience of SSRI's for depression and CBT for GAD (although from all the reading I've been doing recently I think I may fall into the category of rumination OCD!) Once again apologies for the long winded post, but any thoughts/advice/own experiences would be appreciated.

Edited by Hal
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Hi ConcernedMum, Welcome to the forum.

I'm very sorry as a family you're having to deal with the disorder at the moment, but it's a huge positive your son's able to be so open and honest  with you and allow you to help him through this...that really does make such a difference.

9 hours ago, ConcernedMum said:

Without the medication I am not sure he would deal with the ERP parts of his CBT therapy, at the same time although I want nothing more than for him to be rid of these horrible thoughts, if an increase in medication (assuming the side effects are short term and he can cope with them) removes them completely will the CBT therapy be as beneficial? 

I absolutely agree with you, athough it's more than possible to engage in CBT and tackle the exposure exercises without medication, if someone's able to tolerate any side effects, they can go a long way towards making the course of treatment not necessarily easy, but that bit easier than it might otherwise be.

I think you're absolutely right too tho' in wanting to prioritise the role of the CBT over the medication.. the thing to bear in mind with meds is they won't and unfortunately can't remove the intrusive thoughts your son's experiencing. In essence SSRI's are obviously given to help mood with the added hopeful bonus of reducing anxiety, but the intrusive thoughts will still occur, as they do for everyone with or without OCD.

The goal of treatment's to get to a place where the thoughts will still pop up, but your son will able to dismiss them quickly as nonsense and of no importance...the CBT will help him reach that point.

I can completely understand he might be tempted to think well there's no need to continue with the therapy if the medication's helping so much.

But it really is as you say important he develops and attains an armoury of cognitive tools to help him if the meds either begin to lose some of their effectiveness over time, or if he decides to come off them at some stage in the future.

I really would urge your son to keep going with the CBT while on the meds (while keeping an eye on the side effects) the two combined will mean he stands a very good chance of overcoming the disorder. How are you tho,' are you okay?

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Hi Hal, thank you for your reply.

Thankfully he is keen to continue the CBT sessions. Other than the introductory session he's only had 4 so far but already thinks it will help him, but without the meds I'm not sure he'd have been able to continue at university - he's in the final year of his degree, and lives away from home during term time. This has made it somewhat harder for myself and my husband, however we talk regularly and see him at least once a week as we take him to his therapy sessions....we followed advice on this site and chose a BABCP accredited therapist rather than one most convenient for location. 

With regards to my own mental health (thanks for asking), I have been feeling incredibly guilty, since if there is a genetic element, there is no doubt that it has come from me. However, I am aware that I can best help him by also keeping myself healthy. I am fortunate that I have a supportive family, and I am also keeping a check on my own feelings, and prepared to re-visit CBT if necessary. I had 9 sessions through IAPT just over a year ago.

Once again, many thanks for your encouraging comments/advice.

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I'm relieved he's seeing someone through the BABCP. I've lost track of the people who haven't accessed the best private support and treatment because they haven't taken your steps. I'm also pleased he's being proactive in his own recovery, unfortunately that doesn't always happen either.

I hope at some stage you can lay that guilt aside, I really think it's completely unwarranted. The jury's still firmly out in terms of cause (s) and whether genetics are involved, but if they are (and it's a huge if) other factors must come into play too and probably play much more of a role. In some respects you could argue if you didn't have your own experience with the disorder you might not have been able to spot the signs in your son and know how best to help him. You're also doing all you can to help and support him through this, not all get that...to me that's the definition of a good parent.

I'm glad you're looking after yourself too..if you ever feel you need more support and would like to chat..the OCD-UK community is amazing and always here at any time.

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@ConcernedMum I am sorry to hear about the struggles your son is going through, but I wanted to take a moment to thank you and your husband for being such dedicated advocates for him.  As a sufferer who benefitted greatly from my parents own battles to get me properly diagnosed and treated when I started experiencing my own OCD, I know how much a difference that can make.  Your son is incredibly lucky to have you both in his life supporting him and fighting for him.  You are an example of what all parents should be and I'm certain your sons life is better off because of you.
 

On 04/01/2020 at 07:08, ConcernedMum said:

With regards to my own mental health (thanks for asking), I have been feeling incredibly guilty, since if there is a genetic element, there is no doubt that it has come from me.

Mental health problems seem to run in my fathers side of the family, he himself exhibits signs of low levels of OCD himself.  But I don't blame him even one bit for my OCD, even if it did come from his side.  He didn't intend for me to be this way, there was no way he could control it.  He loves me and has supported me my whole life, without him I obviously wouldn't exist.  And I am much happier to have existed even with OCD, than the idea of never existing at all.  So please try to not feel any guilt, you aren't at fault, you gave your son the gift of life, that is a blessing.  Everyones life will be a combination of ups and downs, thats not your fault at all.

Finally, speaking from experience as someone who relied primarily on medication for the first roughly 10 years of my OCD journey, I definitely second Hal's comments on the importance of CBT with or without medication.  I have been fortunate in that medication is highly effective in helping me manage my OCD, most of the time. Unfortunately when it hasn't done its job so well I was often unprepared and things probably got worse than they otherwise would have been.  Fortunately I was able to access CBT during my university years and beyond and that made a big difference in my journey since then.  Maybe your son will need the medication only for a short time, maybe, like me, he'll be on it long term, but I think CBT will always be worth it and is of great importance.  The tools you can use from CBT work regardless of whether one is taking medication or not, and you can use them anywhere at anytime.  Its a great safety net.

Best of luck to your son and your whole family on this recovery journey.

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@dksea Thank you very much for your kind words and for taking the time to post and share your own experiences with medication and therapy. We are very much at the start of our journey in tackling this horrible condition but hope to learn as much as we can to help and encourage my son with his recovery.

I wish you the best as you continue with your own journey.

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