High dose Zoloft v high dose Lexapro

[Chandleresque]

Anyone been on 30-40 mg Lexapro who has had better results with high dose Zoloft 200 mg or above?

[Iceberg]

You’re on 40 of lexapro? 

[Chandleresque]

Yes. Started at 20Mg about 15 years ago. Tolerance developed. Or OCD has gotten worse over time requiring titration. The Pubmed research shows these high doses have been tested even to 50 mg with some people needing this dose for response. 
 

I have had an ECG done several times to ensure no qt interval issue per the warnings that went out a few years back re max doses of citalopram and possibly a concern with escitalopram.

of note 400 mg of Sertraline has been trialled with a better response than 200 mg In OCD in some patients.

 

[Juniper29]

Wow. I know everyone is different, but I had crazy side effects on 200 mg of Zoloft. I can't imagine going higher.

[Iceberg]

2 hours ago, Chandleresque said:

Yes. Started at 20Mg about 15 years ago. Tolerance developed. Or OCD has gotten worse over time requiring titration. The Pubmed research shows these high doses have been tested even to 50 mg with some people needing this dose for response. 
 

I have had an ECG done several times to ensure no qt interval issue per the warnings that went out a few years back re max doses of citalopram and possibly a concern with escitalopram.

of note 400 mg of Sertraline has been trialled with a better response than 200 mg In OCD in some patients.

 

Have you tried other things/combos? I know that OCD does sometimes require higher doses, but at that high you might see more benefit from using a targeted adjunct med

[Chandleresque]

Yes. I also take Aripiprazole 7.5 mg which works wonders. Don’t have Brexpiprazole in my country yet (New Zealand) so APZ has to do.

 

 

[Iceberg]

4 minutes ago, Chandleresque said:

Yes. I also take Aripiprazole 7.5 mg which works wonders. Don’t have Brexpiprazole in my country yet (New Zealand) so APZ has to do.

 

 

Many people on here have said that brexpiprazole isn’t necessarily better anyway, especially for OCD 

[mikl_pls]

Could you possibly go higher on the aripiprazole? Like 10-15 mg? It's very good for augmenting SSRIs for OCD. Another good antipsychotic (well, I say "good" but it has pretty bad side effects) is risperidone. Olanzapine is good too but very diabetogenic. Ziprasidone might be another weight-neutral one to consider if you don't want to go up on the aripiprazole.

Otherwise, memantine + lamotrigine have been studied together and individually for OCD. Any medicine that blocks glutamate release or glutamate receptors will generally help too. Even riluzole (off-label of course).

[CrazyRedhead]

@Chandleresque, have you ever tried the AD Anafranil (clomipramine) ?.......It is in the TCA class of ADs.....Reportedly, it is the "gold standard" for OCD, and FDA approved for treatment of OCD.

Also, Luvox (fluvoxamine), which is an SSRI, is also FDA approved for OCD.

Just my two cents.....

Edited December 31, 2019 by CrazyRedhead

[Iceberg]

@CrazyRedhead might be on to something with looking at anafranil 

[Chandleresque]

Did try anafranil first when diagnosed 25 years ago and did well but side effects became debilitating in social situations eg sweating excessively and dry mouth a real problem otherwise an excellent med.

 

i went back to it many years later but only the generic was available and just didnt work as well.

I proposed memantine to my Dr but they frowned on it and a recent trial as augmentation showed no clear benefit as adjunct to an SSRI for ocd.

 

will stick with current regimen but focus on mindfulness based CT for improvement

 

[Iceberg]

Have you ever done erp (exposure response prevention) therapy? It can be really helpful for ocd