Now sometimes the first med that we try doesn't do the job, as we
mentioned before. After a fair trial (remember, that means long enough at
the correct dose), if the medication isn't doing its job or if the side
effects have been intolerable and unmanageable, then we might consider
switching medications. In some cases we may try adding medications. For
instance, some people have a mild insomnia with Prozac. One of the
unfortunate problems of using the Valium-class of meds as sleeping
medications is that they change the quality of sleep, so you may not feel
as refreshed as you would otherwise. On the otd¸¿¾fps always
preA!-ble to getting no sleep at all! However, another medication called
Trazodone (or Desyrel) acts like a weak SSRI, but as a side effect it is
very sedating. Taking Prozac in the morning and Trazodone in the evening
is an effective way to deal with the sleep problem and enhance the anti-OCD
quality of the Prozac at the same time. Trazodone also doesn't have the
negative side-effects of other sleeping pills, in that it doesn't change
the quality of the sleep you get (the so-called sleep architecture), and it
is non-addictive. Other additions that are have been found to be effective
for some people is to combine a low dose of Anafranil with a moderate dose
of Prozac. This turns out to be very good anti-OCD treatment for some
people, and for them the stimulation of the Prozac may be balanced out by
the sedating effect of the Anafranil. In addition, the dose of Anafranil
may be low enough that the other potential side effects are not noticeable.
As we mentioned before, a few people don't benefit from meds. Some of
these people can do behavior therapy with success. And let me make sure to
mention that being on medications will not, in any way, keep you from
getting benefit from behavior therapy. You will still be able to do the
assignments and learn the skills. In fact, if we can briefly treat your
OCD medically so that you can learn the behavior therapy and start inducing
serotonin changes in your brain on your own, then you can wean yourself off
meds. That is our target, so don't be concerned about combining the two
approaches.
Three last comments about medications. First, all of the medications that
we have for treating OCD are the products of years of research. However,
our research is moving so fast that some of this information you've read
here may be out of date in a year or so. It's a good idea to keep asking
your doctor for medication updates. Second, most of this research would
not be possible if not for volunteers with OCD. So if you can make the
time and are not opposed to taking part in research protocols, we urge you
to call the various research programs and find out what they are doing.
You can always decide not to take part after you find out what's involved.
Many of them don't involve taking medications that you're not taking now,
while some will provide free meds while you're in the program. Most don't
involve any kind of invasive procedures, and some will even pay you for
your time and effort. Please check into it; it's the best way that we have
to develop new and more effective treatments for OCD. And third, we need
to remind you once again to make sure that you direct all of your
medication questions or potential changes to your own medications doctor.
He or she knows you the best, and should ALWAYS be consulted about changes
in medications.