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Why Am I Unable To Overcome Intrusive Thoughts Regarding My Death While Taking Lexapro And Luvox For Panic Attacks?

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Posted on Fri, 10 Jan 2014
Question: My question is for a mental health professional. I have had intrusive unwanted thoughts about my own death for quite some time. I was on prozac 80 mg for 9 years after I had my first daughter 21 years ago. I then had another bout with the same thing about years later and my doctor took me off of prozac and put me on lexapro. It worked for seven years and now I am once again battling the thoughts of how old I am getting and my imminent death. I cannot seem to let go of the feeling, and everytime I think of my death I go into a panic attack. I was put on 50 mg of luvox 13 days ago and my doctor raised the dose to 100 mg yesterday. I have also been on 10 mg of zyprexa for 1 month. My question is why isn't anything working for me this time? I feel paralyzed and scared all the time.
doctor
Answered by Dr. Srikanth Reddy (8 hours later)
Brief Answer: OCD is a difficult illness to treat Detailed Answer: Hello, Thanks for choosing health care magic for posting your query. I have gone through your question in detail and I can understand what you are going through. OCD is one of the difficult illnesses to treat. Only aroun 60-80% of them attain partial or complete remission and rest all stay back with their depression.This is unline depression and other anxiety disorder where the prognosis is still better. But there are good drugs available now in the market which has improved the prognosis. There are 4-6 effective therapies of which you have tried three of them: Fluoxetine, fluoxamine and escitalopram. All these three are standard therapies and should have responded but unfortunately this was not the case with you. Coming to the other options, clomipramine is a an old drug and has special efficacy with OCD which has not been tried for you. Infact it can be added to one of the earlier drugs that you were taking. Also there is a new role of a drug called Memantin in OCD. Along with these medications, you should also put efforts into getting cognitive behavioural therapy which will try to alter your way of thinking and surely reduce distress. There is no need to feel scared. OCD is never a critical or fatal illness and with these new medicines and the add on OCD, the symptoms will surely go down. Hope I am able to answer your concerns. If you have any further query, I would be glad to help you. If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback. In future if you wish to contact me directly, you can use the below mentioned link: bit.ly/dr-srikanth-reddy Wish you good health, Kind regards Dr. Srikanth Reddy M.D.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Srikanth Reddy (12 hours later)
Your response doesn't sound very promising for me. Are you saying my thoughts of death are depression or OCD? So you don't think Luvox 100 mg will help these thoughts? If you think the luvox and 10 mg daily of zyprexa won't help these obsessive thoughts how long until I see some improvement in them going away? Will the panic attacks subside too? Your answer made me feel hopeless
doctor
Answered by Dr. Srikanth Reddy (13 hours later)
Brief Answer: 60-80% is a good number Detailed Answer: Hello Thanks for using health care magic for posting your follow-up query. Thoughts of death is intrusive thoughts and they are cause of OCD. But if these thoughts have persisted for long then the distress it causes does lead to depression as well. The first line treatment of OCD is with antidepressants and hence you have to take care of both of them together. You have been on luvox 100mg for 2 weeks now and you should continue it for atleast 1-2 months to look for the response. If there is no response at the end of 2 months then you should consider adding it up with another drug like clomipramine. Zyprexa 10mg may not help your illness. OCD is an anxiety disorder , as is panic disorder. So the treatment of OCD will take care of the panic attacks as well. 60-80% response is a good response rate and you should not feel hopeless. Persistence is the key and you need to put in persistent efforts. Clomipramine is good option which can be used as an add on. Hope that helps Regards Dr. Srikanth Reddy
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Srikanth Reddy (10 hours later)
Is there a reason why I am ruminating about my death? I don't understand why I am stuck on this thought. I then go into panic mode when I think of actually dying. Will the meds help these thoughts end? I feel like I have nothing ahead to look forward to.... Only death. Why can't I constantly think of something simple... Why the worst thought ever?
doctor
Answered by Dr. Srikanth Reddy (12 hours later)
Brief Answer: OCD is so. Detailed Answer: Hello Thanks for the follow-up question. OCD is an illness where in you get the thoughts that will distress you. If you are particular about the hygiene, then you will get the thoughts that there is some contamination. If you consider sex as a taboo word then you will have sexual thoughts. Now that you are afraid to die, you get thoughts about death. That is the reason you are distressed about it. Regards Dr. Srikanth Reddy
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Srikanth Reddy (12 hours later)
Will the medicine take my fear of dying thoughts away so I can function? I am having such difficulty with this. What is causing such fear of death? Thank you, XXXXXXX C.
doctor
Answered by Dr. Srikanth Reddy (9 hours later)
Brief Answer: Yes Detailed Answer: Hello Thanks for the follow up. Yes it will help in reducing and if possible dissappearing your thoughts about death. Thoughts of dying occur cause of some problem in the chemical balance of the brain which needs to be corrected. Regards Dr. Srikanth Reddy
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Srikanth Reddy

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Why Am I Unable To Overcome Intrusive Thoughts Regarding My Death While Taking Lexapro And Luvox For Panic Attacks?

Brief Answer: OCD is a difficult illness to treat Detailed Answer: Hello, Thanks for choosing health care magic for posting your query. I have gone through your question in detail and I can understand what you are going through. OCD is one of the difficult illnesses to treat. Only aroun 60-80% of them attain partial or complete remission and rest all stay back with their depression.This is unline depression and other anxiety disorder where the prognosis is still better. But there are good drugs available now in the market which has improved the prognosis. There are 4-6 effective therapies of which you have tried three of them: Fluoxetine, fluoxamine and escitalopram. All these three are standard therapies and should have responded but unfortunately this was not the case with you. Coming to the other options, clomipramine is a an old drug and has special efficacy with OCD which has not been tried for you. Infact it can be added to one of the earlier drugs that you were taking. Also there is a new role of a drug called Memantin in OCD. Along with these medications, you should also put efforts into getting cognitive behavioural therapy which will try to alter your way of thinking and surely reduce distress. There is no need to feel scared. OCD is never a critical or fatal illness and with these new medicines and the add on OCD, the symptoms will surely go down. Hope I am able to answer your concerns. If you have any further query, I would be glad to help you. If not, you may close the discussion and if possible you may rate the answer for me, so that I get a good feedback. In future if you wish to contact me directly, you can use the below mentioned link: bit.ly/dr-srikanth-reddy Wish you good health, Kind regards Dr. Srikanth Reddy M.D.