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Increasing meds dosage: how long to feel effect?


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SSRIs are often said to take 4-6 or 6-8 weeks to take effect and that with OCD it can even take 8-12 weeks with OCD. I was wondering how long does it take to feel the effects of an increased dosage? I was on 150mg of Sertraline and have just gone up to 200mg as of yesterday. Is the 200mg effect (as opposed to 150mg) going to take another 4-6 weeks until my body fully embraces it? 

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It's very subjective what effect any SSRI drug may have on any particular patient. 150 mg is a big dose in itself, and often the medication acts as a secondary( caused by the OCD)  anti-depressant and reduces anxiety, but may not have a direct effect on the OCD. So it acts as "water wings" to help the patient engage with CBT - learning to face out intrusions and change our behavioural response to them with CBT is the way to tackle the OCD .

So this begs the question as to why you are increasing the doseage,  what you and your doctor are hoping to achieve by it? And where you are with utilising CBT?

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Posted (edited)
46 minutes ago, taurean said:

It's very subjective what effect any SSRI drug may have on any particular patient. 150 mg is a big dose in itself, and often the medication acts as a secondary( caused by the OCD)  anti-depressant and reduces anxiety, but may not have a direct effect on the OCD. So it acts as "water wings" to help the patient engage with CBT - learning to face out intrusions and change our behavioural response to them with CBT is the way to tackle the OCD .

So this begs the question as to why you are increasing the doseage,  what you and your doctor are hoping to achieve by it? And where you are with utilising CBT?

thanks for the response :)
I’m not sure I entirely understood that first paragraph, can you dumb it down for me? Are you saying that SSRIs only help OCD indirectly by reducing anxiety symptoms? If so yes I agree, that’s my experience. 

50mg for 3.5 weeks did nothing 

100mg for 3.5 weeks did nothing 

150mg for 3.5 weeks had a modest impact, but seemed to have an immediate impact (possibly placebo, or just the timing of how long I’d been on SSRIs, and therefore coincidental, but I sensed not.) 

So, we thought there’s no harm in doing in 200mg seeing as I have had no problematic side effects. 

Yes, CBT stuff has been an ongoing process. 

Edited by OCD Scott
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46 minutes ago, PolarBear said:

Unknown but I suggest any increased benefit will not take quite as long to realize as initially going on an SSRI.

Thanks for the reply. Yes that was my sense as well, as I’ve already built up a tolerance. 

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6 minutes ago, OCD Scott said:

I’m not sure I entirely understood that first paragraph, can you dumb it down for me? Are you saying that SSRIs only help OCD indirectly by reducing anxiety symptoms? If so yes I agree

Generally yes, though for some an SSRI may have a direct effect on their OCD. 

Reducing anxiety symptoms can be done using a betablocker under careful doseage from a GP as their primary aim is to reduce high blood pressure - so the dose has to be linked to the patient's blood pressure and monitored. 

I use propranolol in this way. It responds quickly and reduces anxiety straight away. There is no lead in time by my recollection. It works by blocking the action of certain hormones that create the anxiety response. 

So this is another option you might pursue 

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3.5 weeks is not enough time. I see you up dosed 3.5 + 3.5 + 3.5. So that’s about 11 weeks, within the 8 to 12 weeks period. So you might just be feeling effects from your first dosage.  Doubling dosage hoping to see effects sooner is risky due to possible side effects  

The person to ask for clarification is your doctor.

 

 

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On 05/03/2021 at 19:41, taurean said:

Generally yes, though for some an SSRI may have a direct effect on their OCD. 

Reducing anxiety symptoms can be done using a betablocker under careful doseage from a GP as their primary aim is to reduce high blood pressure - so the dose has to be linked to the patient's blood pressure and monitored. 

I use propranolol in this way. It responds quickly and reduces anxiety straight away. There is no lead in time by my recollection. It works by blocking the action of certain hormones that create the anxiety response. 

So this is another option you might pursue 

Thanks for the tip re beta-blockers and Propranolol. Something to consider, indeed. 

 

 

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Posted (edited)
22 hours ago, Handy said:

3.5 weeks is not enough time. I see you up dosed 3.5 + 3.5 + 3.5. So that’s about 11 weeks, within the 8 to 12 weeks period. So you might just be feeling effects from your first dosage.  Doubling dosage hoping to see effects sooner is risky due to possible side effects  

The person to ask for clarification is your doctor.

 

 


Thanks for your reply.

Yes, it’s chicken or egg territory. 

I am aware that in theory it is my doctor, but I am not speaking to her for another six weeks and she said she didn’t know much about OCD and she says these SSRIs can take time. I’ve read up about it a lot and frankly I often find many doctors don’t know a great deal about OCD.

Edited by OCD Scott
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On 05/03/2021 at 19:41, taurean said:

Reducing anxiety symptoms can be done using a betablocker

Beta blockers only have an effect on some of the physical effects of anxiety.  They work on blocking stress hormones and largely reduce heart rate, sweating etc.  They have no effect on mood.  I have only ever found them to have very limited effect on anxiety.  

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Scott, you should also look at why you have more anxiety than you need. Even though it may seem useless at times, there is a purpose for anxiety. These feelings and symptoms are a part of our innate way of dealing with stress. Known as the fight-or-flight response, anxiety is meant to protect us from danger and allow us to react faster to emergencies.
 

Caffeine mimics anxiety. Alcohol can cause Alcohol Anxiety because it changes levels of serotonin & neurotransmitters in the brain. 

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2 hours ago, Caramoole said:

Beta blockers only have an effect on some of the physical effects of anxiety.  They work on blocking stress hormones and largely reduce heart rate, sweating etc.  They have no effect on mood.  I have only ever found them to have very limited effect on anxiety.  

I think it depends on how the anxiety is expressed. 

Mood is down to changing our behavioural responses and the SSRI antidepressant capabilities. It's typical to experience secondary depression from OCD. 

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What can also help is to learn and practice some relaxation skills. 

There are very simple methods that only need a few minutes. 

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Hi Scott

As mentioned you should seek clarification from your doctor or other medical specialist. Mood is generally defined in terms of generalised

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 feelings that last some weeks and mood disorders generally refer to clinical depression and bipolar. Veale and Wilson say on page 354 in Overcoming OCD when SSRIs do not work in certain circumstances ‘best discussed with a psychiatrist experienced in the treatment of OCD’. Veale on of the authors of the book is a trained psychiatrist. But I personally give the increased dose of SSRls. But am no expert!

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9 hours ago, OCD Scott said:

 

I am aware that in theory it is my doctor, but I am not speaking to her for another six weeks and she said she didn’t know much about OCD and she says these SSRIs can take time. I’ve read up about it a lot and frankly I often find many doctors don’t know a great deal about OCD.

That may be so, I agree, many doctors don't have a full understanding of the extent of how OCD can affect a sufferer.  That said, they do understand prescribing of medication and the available data regarding dosage for various conditions.

Understandably, you are looking for a solution to  deal with the distress that your OCD is causing to your well-being. Sadly, I don't think increasing your medication (unsupervised) is that solution.  Medication can help in some people.  Does it cure OCD? I don't believe so.  Were it so successful we would read countless reports from sufferers detailing how they were prescribed a particular medication and how it resolved their problem.  Looking at this forum alone, I observe large numbers of people who take these medications (often for years) who show no significant improvement, who still suffer from OCD quite severely.  There are others who report a reduction in the intensity of their symptoms, enabling them to engage successfully with CBT.  CBT can help a sufferer to change their response and behaviour in a way that transforms their life.  There are others who can do this without medication.

Hopefully, medication will help if you can find the right medication and the right dosage.  You look to have taken the medication for at least 3 months and it should be starting to show some benefits.  Upping the dose may not be the answer, it may make you more anxious (as you've found).  It may be that you just need more time on the 150mg dose alongside working at the CBT.  I doubt you'll suddenly find a dose that will switch this off and make it stop.  If you're unhappy with your progress, don't wait the six weeks....perhaps make another appointment to discuss the medication again.  Perhaps ask if there are any benefits in being referred to a Psychiatrist who has more specialist knowledge in prescribing.  As I mentioned earlier, these are prescription only drugs for a reason and I urge anyone to seek advice off their prescriber before changing the prescription.

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Sorry, I see you have two threads running with the same topic and that (in the other) you explain that the Incease in dose was a decision made In conjunction with your GP.  Also, that thus only took place last Thursday.  It may be that the increase has increased your anxiety and hopefully it will settle down.  Stick with it and see how you progress.  If the anxiety remains intolerably high, make a telephone appointment with your GP & discuss it with her.

It's helpful to try and keep one topic in one thread, it's far easier to follow for all.  I did wonder about merging the threads but it might make continuity difficult to follow but can we stick to one or the other as we move forward :)

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