Suggest Treatment For Anxiety And OCD

Posted on Sat, 22 Nov 2014

Question: I am on Lexapro 40 mg since more or least three weeks, Keppra 1500 mg as mood stabilizer, Klonopin 2mg and Solian 100 mg (amisulpride), which seems to provoke some OCD symptoms because of agonism of 5HT7 and 5HT2b receptors and some dopaminergic actvity. I would like to know if i can expect more improvement with Lexapro 40 mg in the following weeks (especially the following two weeks), since until now i have an improvement of 80 %, but not at 100% (i don't feel a full recovery), and maybe a higher dosage of Lexapro is necessary (but i am in a high dosage!). My psychiatrist gave me a little bit higher dosage of Keppra (250 mg in the morning), but it's not working and i've been told that Keppra has no anti OCD effects.

Thanks beforehand

Answered by Dr. Seikhoo Bishnoi (45 minutes later)

Brief Answer:
Escitalopram doses are on higher range

Detailed Answer:
Hello

Welcome to Health Care Magic

Before going to discussion a brief summary of your problem. You are a 49 years old male with psychiatric history of anxiety disorder and OCD. There is no allergy history. You are currently taking Lexapro (Escitalopram) 40 mg per day, Keppra (Levetiracetam) 1500 mg per day, Clonazepam 2 mg per day and Amisulpiride 100 mg per day. Recently the medicines provoked OCD symptoms.

Now coming to discussion-

-You are on 40 mg Escitalopram and as per my opinion this is very high dose of this drug. Most of clinicians use the drug to 20 mg doses. Most of guidelines also mention that maximal dose is 20 mg per day. Increasing the dose doesn't increase efficacy of drug but side effect profile increases. So increasing the dose will not help in much improvement. Wait for some time to get complete relief.

Escitalopram at very high doses increases the risk of cardiac arrhythmias. So get your ECG done regularly as you are on high doses.

-Leveratiracetam is an anti-epileptic drug with mood stabiliser properties. The drug is a nice drug with good results. You are on 1500 mg of doses. There are rare case reports that this drug increase the behavioural side effects and obsessive thoughts but these are not confirmed. In high doses aggravation of symptoms may occur.

As per available literature I can tell you that it has not been found to be useful in OCD.

- Amisulpiride and clonazepam are in good doses, no need to change the doses.

Hope this helps you, if you have more queries you can ask again. Please mention you clinical history in detail so that I can comment on your clinical outcome.

Thanks

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Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju