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Summary
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A person’s Obsessive-compulsive disorder (OCD) symptoms returned after stopping Prozac, and they are anxious about whether restarting it at changing doses will help. They want reassurance and guidance about a treatment that previously worked well.
The answer encourages psychiatric oversight and discusses the possibility that medication response can change, with other options requiring clinical consideration.
It particularly emphasizes cognitive behavioral therapy alongside medication and learning relaxation skills, rather than relying on medication alone; it does not provide a definitive explanation for this person’s response.
Question
Reader · Identity withheldI have a question. I am new to this site. I had been on Prozac for about 9 years and it was wonderful. It almost totally alleviated all of my OCD symptoms.
\nWell, I was incredibly stupid and thought I no longer needed medication and weaned off of Prozac last October. Needless to say, my OCD came back full force (worse this time around) in March of this year.
\nI honestly thought I was going to die. Well, after a try on Lexapro which made me tired and more depressed I went back on Prozac. I started on 20 mg eight weeks ago, went up to 40 mg six weeks ago, and now have been on 60 mg for 2 1/2 weeks.
\nThe last time I was on Prozac 40 mg the entire time. Well, I am really scared.
\nSometimes I feel like I am feeling better and at other times I feel awful. I know increasing the dose brings increased anxiety, etc., but should I wait with the 60 mg for an extended period of time or do you think Prozac is not working for me this time????
\nI want this to work again so badly. I know the meds work because it worked for 9 years. I also know I can feel better because I did feel great. Please help me!!!!!!
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Answer
Allan Schwartz, Ph.D.\n
First, let me try to help you by reassuring you that you will get your symptoms under control once again. OCD is an anxiety disorder and you are reacting to this medication issue with great anxiety. So, take a deep breath, relax and think of pleasant things that you really enjoy. More about that later.
\nNine years is a long time to be on one anti depressant. It is common for any one anti depressant to stop working as effectively after a few years.
\nLexapro is an excellent medication but it may it was not right for your particular symptoms and that is not unusual. There are other anti depressants that are very helpful with OCD and one of them is Zoloft.
\nChemically, it is similar to Prozac and would not be a giant leap in terms of the type of medicine your body is used to. Zoloft has even been approved by the FDA for the treatment of OCD.
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Another excellent medication is Paxil and you can be assured that it too will help OCD. Given your level of anxiety at this time, I would recommend Zoloft because you now know that it is approved by the FDA. Psychology plays a big roll in all of this.
\nMy sincere hope is that you are under the care of a psychiatrist. While your family physician is fully capable of prescribing these medications, the psychiatrists are the specialists and experts in this area.
\nWhat I want to especially emphasize to you is the need for psychotherapy to be part of the total treatment process. It seems that you had nine years of Prozac, and that was fine, but you evidently did not have the opportunity to engage in Cognitive-Behavioral Therapy (CBT).
\nThe value of CBT is to help you to learn to control these symptoms with or without medication.
\nAll the research findings are that a combination of CBT and medication work best and that, in some circumstances, CBT alone works well. However, I believe you are too anxious at this point to have CBT without medication. Therefore, you need a referral to a therapist who knows CBT and will use it (with your medication) to help you learn about OCD and how to stop it.
\nTo return to what I mentioned earlier in this posting, you need to learn relaxation techniques, along with treatment, to help you reduce anxiety. Deep body relaxation, deep breathing and meditation are excellent ways to reduce stress and anxiety.
\nThere are classes given at local community centers and colleges for the public to learn to use these techniques.
\nThere are no magic pills. That is why you must learn to do more than rely on medication alone to deal with OCD.
\nBest of Luck.
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