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Best SSRI for OCD (not Luvox)


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I'm just now realizing that a lot more of my problems are actually caused by my OCD and depression than I had previously thought.  Right now I'm on meds primarily for my anxiety and paranoia, but not really for depression or OCD.  I'm on wellbutrin, but not at too high a dose, because I don't want it to counteract the risperdal I take, which is a great drug for me.

So.  I was wondering if any of you could give me some advice as to which SSRI is best for OCD and somewhat  treatment-resistant depression.  Also, when I was a kid, I had a bad reaction to SSRIs (became very angry, etc), but I'm not sure if I would now, as well.  I figure that if I add an SSRI, the wellbutrin will also help the SSRI work better, as will the risperdal, and so maybe it can help me kick a little bit of my depression and OCD.

And advice is welcome.

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I have had the most success with Celexa for my OCD.  I have been taking it for about 4 years and unlike other SSRI's I have been on it does not make me manic.  Sometimes I have to tweak the dosage to account for mild hypomania.  When I took Luvox I never felt any effect on my OCD and it did in fact make me suicidal.  Prozac was absolutely intolerable because of the nausea, but I felt some benefit to my OCD even though it didn't lift my mood at all.  Zoloft was somewhat effective for my depression.  I didn't get very far on Paxil, before I gave up because of increased appetite and sleepiness.

Katie ;)

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I recall that Lexapro (cousin of Celexa) works well for OCD.  The advantage of Lexapro over Celexa is that Lexapro:  has fewer side effects, works effectively at a lower dosage, and results are noticed more quickly.

As far as the effective dosage of Lexapro, your mileage will vary.  The Crazy Meds website on Lexapro states that you go no higher than 20 mg of Lexapro per day, but I take 40 mg/day, and there have been other people who have posted who have taken as high as 40 mg/day.  Lexapro is powerful stuff.

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After Luvox, Paxil would be the next best one to try. Celexa and Lexipro are pretty much tied, and then prozac and zoloft.

In all cases, it usualy takes a much higher SSRI dose to touch OCD so if you're hoping that you can get by on a small dose that doesn't fuck with you're bp, you might not have much luck. 

You might be better off with clomipramine, a TCA which was the fist med approved for OCD.  The side effects are typicaly a bit worse than the SSRIs but you might be able to squeek by at a lower dose.

Of the APs, seroquel and geodon have anti-obsessive properties.  A combination of Cymbalta and Seroquel has rendered my OCD tolerable.

Here's some reading material for you:

http://www.vh.org/adult/provider/psychiatry/CPS/37.html

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After Luvox, Paxil would be the next best one to try. Celexa and Lexipro are pretty much tied, and then prozac and zoloft.

In all cases, it usualy takes a much higher SSRI dose to touch OCD so if you're hoping that you can get by on a small dose that doesn't fuck with you're bp, you might not have much luck.

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After Luvox, Paxil would be the next best one to try. Celexa and Lexipro are pretty much tied, and then prozac and zoloft.

In all cases, it usualy takes a much higher SSRI dose to touch OCD so if you're hoping that you can get by on a small dose that doesn't fuck with you're bp, you might not have much luck.

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  • 1 month later...

Why paxil?

It is recognised as a slightly sedating ssri which makes it better for obsessional and anxiety disorders for the majority of people, over say prozac or zoloft.

Lexapro is also a good choice, being the most selective ssri it tends to have the least side effects.

I personally find paxil much better than luvox, and am quite happy with it.  If it pooped out on me I wuld probably try celexa or lexapro.

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  • 2 weeks later...

What are the chances if Paxil didn't do enough, Lexapro was great but only for about 10 months (pooped out after that) and Prozac had counter-effects (anxiety, chaos in my head) that Luvox will be an effective AD for major depression and dysthymia?

Thanks!

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Hi All,

I have GAD and OCD.  I've been taking Mirtazapine for the GAD, but my pdoc has just added Zoloft for my OCD.  Big problem- it has made my obsessions ten times worse and has sent my anxiety thru the roof!  I've been taking it for 3 weeks now and i've reduced the dose from 50mg to 25mg.  This has reduced the OCD symptoms a little, but they're still a lot worse than when i first started Zoloft.  Anyone know if this is normal?  Is it worth sticking it out for much longer?  I suspect that Celexa or Paxil may be better for me as they are more sedating, but i'm willing to hang in there with the Zoloft if things are likely to improve....

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ccc:

Do you think it's possible that it cold have send you into a mixed bi-polar state or agitated mania?

If any of the SSRIs are going to trigger bi-polar symptoms, zoloft has the reputation of being the one most likely to do it.

You might want to try a lower dose atypical anti-psychotic instead.  I've gotten a lot more relief from obsessions and intrusive thoughts from Seroquel than I did from any of the SSRIs.

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Jules.  It's very worth a try.

Keep in mind that OCD often requires SSRI doses much higher than what is needed for other indications.  It not unusual to have to take more that the recommended max dose.

Needless to say, you might have to find an open-minded pdoc to be able to do this.  If your pdoc isn't willing to go up to doses like 60-80 mgs of paxil or 120mgs of prozac, you might be better off with an anti-psychotic.

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Another drug you might want to ask your doctor about is Topamax. There's some studies showing that it is good for OCD. Here's a study that shows this:

http://www.macleans.ca/topstories/health/a...221_103310_5028

It is said that OCD can be caused by excessive glutamate, and Topamax lowers glutamate levels. In the study, 70% people had their OCD symptoms much to very much improved on Topamx. Many of them have almost no symptoms on it. Topamax is also reported to be good for PTSD, so it's good for intrusive thoughts as well which is part of OCD. Some other studies report that it helps some with depression, too.

I took Luvox recently, and it caused some worsening of cycling and bipolar depressive symptoms, so my doctor switched me to Topamax. I took one time, and it seemed to help w/ intrusive thoughts. I'm taking it for bipolar ultradian cycling.

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