Question: I am 34 years old and a couple of years ago I had an onset of horrible anxiety now diagnosed as OCD (intrusive thoughts). I tried Paxil, with no luck, and was on Zoloft with about 50% control combined with therapy. Two months ago my therapist encouraged me to wean from Zoloft. I am now having terrible relapse and want to begin medication again.
Have you had any experience with Effexor helping with OCD? Do you feel one SSRI is better at controlling OCD than another?
Answer: There is limited research that compares one SSRI to another for OCD. There is some evidence that Anafranil (Clomipramine) is better because it combines the SSRI effect with a norepinephrine reuptake inhibitor effect. But Anafranil also has more side-effect issues.
There was one study where people with OCD responded fairly well to Effexor XR. At doses of 150 to 225mg Effexor has the benefits of Anafranil without all the extra side-effects.
I have patients who have benefited from all of the above but there’s no way to predict who will do best on what.
It’s always important to also do the cognitive behavior techniques described in the book Brain Lock (available at Amazon.com). I prefer that people listen to the tape because the author not only tells you what to do he shows you how to talk to yourself.
A lot of patients don’t get an adequate response to an SSRI or Effexor XR even after 12 or more weeks and even doing the Brainlock techniques. Often adding Clonazepam (also available as Klonopin wafers-quicker acting sublingual) or Abilify usually low dose of 2.5mg (or other atypicals) can help get symptoms under control. Sometimes stimulants help because they increase your control of what you focus on.
The bottom line is you keep making adjustments until you find what works. In the rare instance that nothing works adequately you won’t have to wait long. There’s always something new coming.
This article originally appeared in the Q&A section 06/17/2005.
