I suffer from ocd since the age of 11, I am now 36. Started taking antidepressants at age 21. Was on Paxil 40mg for 10 years then reduced and took 20mg for 4 years.

Because of the sexual side effects, decided to try other medications. Tried Effexor, felt too anxious on it, had to take alprazolam. Stopped that. Am presently taking 20mg escitalopram, Cipralex.

It's been 2 months now. I am not feeling much better than with 20mg of Paxil. My doctor says 20mg escitalopram is equivalent to 30mg Paxil and 40mg Celexa. But for me, it does not feel any different than 20mg Paxil.

Since Cipralex only slightly affects NE and does not affect dopamine, do you think that is why it does not work as well for me? Maybe I need a medication that works on NE and dopamine as Paxil did.

I am confused and scared to go back on Paxil because of all the bad publicity it has been getting. Is there another medication you think would be worth trying or a combination of medications?

Tks,
jennifer

Dear Jennifer,

You are asking a very important question. What is the best medication for Obsessive Compulsive Disorder, or OCD.

In my opinion that drug is Clomipramine or Anafranil. This was the original medication that showed a positive effect for OCD. The original reason for this effect with Anafranil, was that it was the only antidepressant that had an exclusive effect on Serotonin.

All other antidepressants had an effect on Serotonin, but also Norepinephrine, which seems to diminish the positive effect of medications that exclusively promote serotonin.

It seems that the culprit in OCD is serotonin. The problem with Anafranil is that it has a host of side effects that limit it's use. In my opinion, only medications that work exclusively on serotonin are helpful for OCD. Sometimes, the addition of an anti-psychotic medication will also help (risperadone, olanzapine, quetiapine).

Of course, all psychiatric medications should be augmented by talking therapy which promotes behavioral and thinking or cognitive changes. The antidepressants that also are almost exclusively seratonin enhancing or serotonergic are paroxetine or Paxil; fluvoxamine or Luvox; sertraline or Zoloft; citalopram or Celexa; escitalopram or Cipralex; Fluoxetine or Prozac. That is in no order of effect, because different people respond differently to these different medications.

Effexor can work also, but It is hard for me to understand because it is not purely a serotonin enhancing medication. The other important issue is that the effect of these medications can take a while to occur (8 to 12 weeks) and the dose is usually higher than for depression or other forms of anxiety.

You need to work with your doctor to find what works best for you in terms of effect and side effects. I certainly hope this helps, as OCD is a painful condition. It is even more so if you have bipolar disorder with it, as often antidpressants can make the bipolar disorder worse, even though the OCD should improve. My order of favorite medications for this condition would be Cipralex, Celexa, Prozac and Anafaranil. But whatever works best for you is the most important thing. Good luck.