[ 會員#25776 ] Sam
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?
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?
張逸和醫生回覆:
5/7/2022
5/7/2022
Dear Sam
Thank you for your 3rd Enquiry.
Many other doctors including me have tried their very best to address your concerns. Your case is obviously a case of Refractory Anxiety Disorder +/- secondary Depression. Unfortunately most of the 1st line treatment options including medication and psychological treatment have all been exhausted. MAOI is available in USA but it is not worthy to fly to USA for consultation in view of Covid-19 policy. Esketamine is not indicated for refractory anxiety disorder but indicated in Treatment Refractory Depression.
I think the focus of your treatment plan has to be readjusted at this stage since full remission is quite difficult. The aim is to adjust, to cope positively, to live with the symptoms, to maximize your functioning via various measures, to reduce the disabilities involved, to simplify your drug regimen and to reduce the possible side effects that may impact on your functioning.
This is something you can discuss with your treatment team especially your doctor who lead multi-disciplinary team to achieve this target. Our previous recommendations were to be honest, may not be matching to your needs as we did not have an in depth understanding of your condition without a proper assessment.
Take Care. My best wishes
Dr CHEUNG Yat Wo Eric
Thank you for your 3rd Enquiry.
Many other doctors including me have tried their very best to address your concerns. Your case is obviously a case of Refractory Anxiety Disorder +/- secondary Depression. Unfortunately most of the 1st line treatment options including medication and psychological treatment have all been exhausted. MAOI is available in USA but it is not worthy to fly to USA for consultation in view of Covid-19 policy. Esketamine is not indicated for refractory anxiety disorder but indicated in Treatment Refractory Depression.
I think the focus of your treatment plan has to be readjusted at this stage since full remission is quite difficult. The aim is to adjust, to cope positively, to live with the symptoms, to maximize your functioning via various measures, to reduce the disabilities involved, to simplify your drug regimen and to reduce the possible side effects that may impact on your functioning.
This is something you can discuss with your treatment team especially your doctor who lead multi-disciplinary team to achieve this target. Our previous recommendations were to be honest, may not be matching to your needs as we did not have an in depth understanding of your condition without a proper assessment.
Take Care. My best wishes
Dr CHEUNG Yat Wo Eric
以上資料只供參考，不能作診症用途，
請與家庭醫生查詢並作出適合治療。
如有身體不適請即求診，切勿延誤治療。
若資料有所漏誤，本網及相關資料提供者恕不負責。
請與家庭醫生查詢並作出適合治療。
如有身體不適請即求診，切勿延誤治療。
若資料有所漏誤，本網及相關資料提供者恕不負責。
Zeches331 : 嚴重失眠
本人一直有嚴重失眠問題, 也因如此一直要自醫生, 政府醫生不敢苟同, 只好一直硬著頭皮睇私家醫生, 開始時藥物.......davidtree@yahoo.com : deanxit停吃問題？
我年纪大因病睇私家醫生多年，吃多種藥其中包括吃deanxit已有幾年，每天吃2粒。上年有次就因急症入去政府醫院.......Peter lp : 情緒病問題
我懷疑自己有焦慮症問題，因為佢今年四月焦慮問題搞到唔舒服，有一日終於情緒爆發，過咗一段時間都係食唔落野同成日見.......Stephen : 躁狂抑鬱症
大家好, 朋友媽媽懷疑忠上躁狂症, 經常因小事或無故大吵大鬧。 而近日因喉嚨不適去看普通科時, 醫.......Leung Pok Sze : 焦慮症
我媽咪有少少焦慮症，無食藥，請問可以坐飛機？ 因為就快到去旅行既日子，佢第一次坐飛機，好擔心會發生咩事，最近.......Peter lp : 病徵問題，請各位醫生幫手。謝謝
間中會頭脹， （只在出街）時會間吾中有d精神恍惚 同 飄暈既感覺，集中吾到精神，不過間隔一陣就沒事 之後就.......Peter lp : 有關神經衰弱（情緒病）問題
半年之前有焦慮症同驚恐症嘅症狀，但係休息左一排同埋自己諗通左好多野，知道呢啲係病嘅情況，食咗大約三四個月中藥，....... 發出提問使用細則
致張逸和醫生 提問
