A question about refractory OCD, GAD and MDD

I have MDD, GAD, OCD and ASD. I have tried Zoloft, Lexapro, Prozac, Paxil, clomipramine, Remeron, Cymbalta, Pristiq, Seroquel, Abilify, Zyprexa, Risperdal, lithium, Depakine, Klonopin, Ativan, Xanax, Lexotan, Inderal and Lyrica. Please see my current prescription below:

1. Fluoxetine 80mg daily
2. Mirtazapine 45mg at bedtime
3. Aripiprazole 30mg daily
4. Olanzapine 15mg nocte
5. Clonazepam 0.5mg tds prn
6. Lorazepam 0.5mg tds prn
7. Pregabalin 250mg om and 250mg nocte
8. Valproate sodium CR 200mg nocte
9. Promethazine 100mg nocte prn
10. Lithium carbonate CR 400mg nocte

After trying so many medications, my OCD, anxiety and depression still make me dysfunctional. I can't resume my university studies or leave my home alone. I see my psychiatrist, clinical psychologist, counselor and social worker regularly. My psychiatrist said she would not recommend ECT. I tried rTMS and dTMS but they don't work. Esketamine and MAOIs are not available. What can be done to bring my OCD, anxiety and depression under control?

林樹強醫生回覆:
5/5/2022

Maybe you should learn to live with the illness. You can talk to the doctor to consider simplifying your long list of medications to minimize side effects if any (e.g. tailing off those added no benefit one by one). Stay on minimal necessary medication first and then try further refining the regimen carefully. Meanwhile you should learn to cope with the symptoms and strive to maximize your functioning e.g. traveling alone. Then set reasonable targets one by one. Rather than putting all your hope on finding a magic drug or any new treatment which can quickly fix all the problems.

Dr Liem

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