Brief Answer:
yes, thoughts run all day & can have false memories

Detailed Answer:
Hello and welcome to health care magic!

I have gone through your query carefully and can understand that your cindition needs attention. You are under treatment for ocd but it dosent seem to give adequate response.
I will try to give you a reply point wise to help in understanding the issues involved.

1. If latuda is not working- like in your case; I prefer adding another molecule or shift to a different molecule. In cases like yours I would prefer something like fluoxamine or may be venelafaxine. It has given me very good response in my severe cases of ocd.

2. There is another drug called- etizolam which is anti anxiety but dosent give any sedation. This may be added to your present regimn to reduce the anxiety episodes and help you get calm without drowsiness.

3. You have tried resperidone with some dizziness problems and had to stop it.
In such cases I try quetiapine.
You may discuss the drug with your team. It is as effective as resperidone but less sedative after three four days of use.

4. Ocd is quite a distressing illness but is tretable and even your presentation is a common one .
Yes, false memories or associations are part of ocd and can create lot of problems for the patient. The repetetive thought are present all day and the patient may even have disturbing dreams at night.

You please have courage and dont loose hope. Its just the matter of time when a right drug and dose clicks you..every person is different ..

5. the best treatment regimn is drugs plus threapy- erp sessions. They help a lot. But start them once there is some control over thoughts ..

6. Till then you can try the above mentioned etizolam after talking to your doctor and practice deep slow breathing or any deep relaxation procedure. The one that I teach is jpmr..it is very helpful.

7. When the ocd relapese aftet delivery it is usually troublesome as the thought of harm is there...but it will get well with proper treatment.

I hope the reply is useful for you.
Feel free to ask more queries for any clarification.
Dr. Manisha Gopal
MD Neuropsychiatry

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Brief Answer:
confusion can be due to drugs or constant chain of thoughts

Detailed Answer:
Hello

I have gone through the follow up query and can see that your persistent repetetive thoughts of harm happening or doing it yourself are troubling you a lot..

Yes, you are right that there is always a feeling and fear that the thoughts will turn into actions..but at the same time the patient wont do anysuch dangerous thing..
The action (of harming others or self ) is usually not carried on by the patient as there is insight .

You are aware that these thoughts are unwanted, undesirable but not in your control. However, as they are undesirable and unwanted the patinet dosent act on them ( while the patient might do harmless activities like washing hands or checking, etc.).

The presence of insight into the illness ( that you also have at present ) differentiates it from psychosis.
At present you dont have psychosis, but surely adding an antipsychtic drug will boost the action of anti ocd drugs to several folds.

Usually the thoughts of ocd have sense to them and with time the patient develops useless connections between some thoughts and actions.

Due to severe anxeity and continious chain of thoughts the patient feels confused and have complaints of memory lapses...forgetfullness.

Severe anxiety can lead to panic attacks or phobia like situations.

please trust me- that the problem that you are facing at present is quite frequently seen in clinical settings and the patients do get better with medications. The repetetive thoughts reduce and finally stop coming after some weeks of the medications.

So,it is not very difficult to treat condition. Please discuss the above points with your treating team as well.

I wish you a speedy recovery and best of health!
Feel free to ask more queries.
Dr. Manisha Gopal
MD Neuropsychiatry

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Brief Answer:
yes, it can be a part of ocd

Detailed Answer:
Hello

Yes, even such thoughts of eating unedible things which come repeatedly and are out of ones control can be seen in ocd.

In Ocd - thoughts or actions which are repetitive, unwanted or undesirable and are recognised of own self but out of ones control can be seen in ocd.

So, any thought that fits in this definition can come in ocd...

Wish you good health

Dr. Manisha Gopal
MD Neuropsychiatry

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Brief Answer:
yes, images can be seen; obsession of calling police is common

Detailed Answer:
Hello and welcome to health care magic!
Sorry for the delay .

You are right in the sense that these thoughts can be present without any actions ..even the imagery can be seen in many patients - where they just imagine some picture or scenes but have never gone through them in their real life (like a red snake in your case).

Its good that you are under erp also ...I can understand that it might not be working that effectively that it should. It is so because (as I had also mentioned earlier in an answer ) of severe anxiety at present. Your mind is not that calm that it can take the erp sessions properly. First and foremost is controlling anxiety to some level and only then the therapy of any kind works!

And erp is wonderful technique and I feel your therapist is good as he is giving you right approaches to handle your thoughts.

And regarding calling police- Iwould like to tell you that this particular obsessive thought is quite common in western settings...I have had some patients who have the similar thoughts which were very distressing to them. They never acted on them or never called police but would always worry about them. One even got the phone disconnected due to the same. So, please dont worry.

You should also go for some dietary changes and life style modifications ..they too help in calming the mind apart from usually drug and therapy approach.

Wish you luck!
Feel free to ask more queries for any kind of clarification.

Dr. Manisha Gopal
MD Neuropsychiatry

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Brief Answer:
if I were treating such patient I would raise the prozac soon.

Detailed Answer:
Hello,

Thanks for writing to health care magic!

I have read your complete query again (including your previous questions to me). Now your doctor has started prozac 20mg and has continued latuda and klonopin.

You have mentioned that last time you had response with 80mg of prozac.

If this is the past history in any of my patient then-

-eithe, I would build up the dose of prozac to 80mg early; because I already know that only at that dose the patient would respond

- or, I would preffrably not start this drug and try a different molecule. (As 80mg prozac is almost the highest recommended dosage and I wont be able to increase it any further if needed).

I think your doctor has put you on prozac because you had responded to it in the past.
Please wait for some days and may be your doctor will raise it to 60-80mg.

Pozac is a good drug and quite commonly used in treating ocd.

You should continue with erp sessions and try some kind of relaxation therapy too.

I wish you good luck and speedy recovery.
please feel free to ask more questions for any clarification.

Dr. Manisha Gopal
MD Neuropsychiatry

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Brief Answer:
improvement in ocd is a gradual process and can be slow

Detailed Answer:
Hello,

Thankyou for repying back.

1. Yes, some cases of ocd might take long to respond...but most start responding within 2 months of start of treatment. Ocd is generally slow to respond compared to depressive illness or anxiety syndrome.

2. Prozac may be given upto 100mg in rare cases but if it is not showing any response on 80mg then there is little improvement seen after raising it any further. So, your doctor is also correct that the dose may be increased.

3. In ocd -repetetive thoughts start reducing in their power- like, first the patient starts feeling that now he has some control over his repetetive thoughts and is able to have some concentration on his works..→
then, there is a feeling of reduction in anxiety and intensity of thoughts. →
Then there is dissapperance of some obessive thoughts out of many..→
then gradually all the obessive thoughts have improvement.

So, the change or improvement in ocd is a gradual process ( the sequence of improvement may differ in different patients).


I hope the reply helps you.
Please ask of there are any more thoughts concerning you.

I hope you get well fast!
Dr. Manisha Gopal
MD Neuropsychiatry

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Brief Answer:
yes, all tgoughts/ urges/ images will be treated by prozac!

Detailed Answer:
Hello,

Yes, both the thoughts and visual images will improve with prozac.

Both the thoughts and urges / compulsive actions are part of obesessive compulsive disorder and all of them get better with treatment. Its not that we need to give separate medication for different symptoms.

There might be several set of symptoms in different patients of ocd but the drug helps them all.

Please have faith and with in some time you will hopefully have good response.

Try to engage yourself in some kind of work..this would help your mind to rest and distract the urges or thoughts as well.

I hope the reply is useful for you.
Kindly feel free to ask more queries for any clarification.

Dr. Manisha Gopal
MD Neuropsychiatry

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Brief Answer:
yes, the voilent urges are debelitating as they cause more anxiety

Detailed Answer:
Hello,

Yes, as I told earlier there may be voilent urges in the patient of ocd. The urges are usually not acted upon by the patient though he might feel so.

The voilent urges are not uncommon but the patient should try to take proper treatment and get well.
Its not the urges that are dangerous but the intensity of the symptoms and the associated anxiety that is debelitating.

I hope reply is helpful for you.
Feel free to ask more questions fir any clarification.

Dr. Manisha Gopal
MD Neuropsychiatry

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