QUESTION:
Dr. Heller,
I have been diagnosed as being clinically depressed and suffering from obsessive compulsive disorder. I had been taking 20mg of Prozac for a prolonged period of time but was switched to a combination of 20 mg of Paxil and Lithium. When I forget to take my medication I panic that I won't be able to make it through the day without all hell breaking loose. To overcome this sense of panic, I am forced to concentrate extremely hard at whatever task is at hand. Sometimes it works, sometimes it doesn't. Am I chemical dependant? Additionally, I have been having problems with erectile dysfunction since starting on this medicinal protocol. Are these symptoms typical of the drug interaction, or am I a victim of something more insidious? Many thanks for your reply, if you are able to find the time.
ANSWER:
I think you need to get all your diagnoses made and established. Lithium has
little use for obsessive compulsive problems or panic. The most established
treatment is SSRI's like Prozac - usually in a higher dose than you are on. High
doses of the vitamin Inositol can also work for OCD problems.
Since you're not on any addicting medications, no you are not addicted. A drug
interaction is very unlikely. High levels of anxiety appear to be your biggest
problem.
The concentrating extremely hard to overcome panic could have lots of explanations,
attention deficit disorder being one of them.
Erectile dysfunction can be from increased anxiety caused by Prozac, a direct effect of
the Prozac, or totally unrelated. If the cognitive generalized anxiety disorder is
present, you'll need to take BuSpar. You may also need medication to block the
serotonin-2 (5 HT-2) receptor like Remeron or Serzone.
The
screening test I use for my patients may be useful to you
in this regard.