Question: Hi - I am a young adult who has pure O OCD. I tended to have pretty bad constant recurring thoughts. It was obvious to me after a while that is was an anxiety disorder that manifested in circular thinking, procrastination, rumination etc. I was particularly obsessed with philosophical questions that had no absolute answer. I ended up realising it was this that made me anxious (e.g. are we living in a matrix?, solipsism, etc.) and that I always had to have absolute black and whites.

When I was younger this used to be more compulsive OCD. I was constantly turning off lights, checking car doors etc. However as I've gotten older I have no more compulsions but unfortunately it had manifested into obsessive thoughts.

I read through quite a few studies and decided to ask my GP to put me on lexapro for it. The results have been truly amazing. I have been on it for 4 months and I finally feel like I can perform my studies and live my life to the best of my abilities. I no longer get anxious about obviously stupid dilemmas/paradoxes etc. I was always aware that the circular thinking was ridiculous but I couldn't help myself from reading enormous philosophical essays etc.

However, I also have persistent motor or vocal tic disorder. I've also had this since I was a kid. I've read the DSM-V guidelines and it's clear that it isn't tourettes since I have always ever had ONE tic that would be swapped for by another tic. It used to be neck spasms and then eye blinking. It then transitioned into vocal grunts and now it is sniffing.

I had always been ardently anti-medication, however given the amazing results of lexapro, I've since changed that view. I hate the tic I now have as it is noticeable by other people and I think it'll affect career prospects etc. I hope to be in something in media so I'm really devastated that I have this.

I have tried to read studies on this, however, I haven't been able to find any good studies on medication OCD and tic disorders.

I've read good results with apiprazole for tourettes and tic disorders in general, and have also seen that it has some kind of therapeutic treatment for Anxiety disorders. I'm also aware it is an atypical neuroleptic, and to be honest that makes me kind of nervous.

Do you think it's best to combine my current 10mg lexapro with abilify? I've heard they interact as lexapro interferes with hepatic metabolism and may increase the side-effects of neuroleptics?

Or do you think I should wean off the SSRI and move onto abilify?

Or is there something else you can recommend?

I anticipate you may recommend just living with the tic disorder (as my GP did), however it has since gotten a little worse and I am genuinely worried I may develop a tic that will be truly embarrassing. I always attempt to avoid informing myself about tourettes or tic disorders because I'm very anxious I'll just develop the tic I watch. I'm definitely not suicidal or depressive at all, and I'm actually really excited about my future and my current passions.

However, I often feel like I would be enormously relieved when I am close to death. I feel like I would just have a huge XXXXXXX and say "I beat it! I went through my life without going completely batshit. I'm so relieved I didn't completely lose my mind and develop tourettes etc." I really don't like living like this so I want to address this problem now.

I hope I didn't ramble to much - I'm eagerly awaiting your response!