QUESTION:
Dear Dr. Heller,
My boyfriend has been diagnosed with OCPD. He has low tolerance for waiting in lines, driving in traffic, imperfection, etc. He tends to get hyper-aroused in these situations and can't seem to regulate his affect. He tried Paxil and it helped, but the anorgasmia and the tolerance led he and his psychiatrist to switch him to Zoloft. He is on 50mg at this point, has some trouble achieving orgasm, and isn't having any decrease in OCPD symptoms.
I have done some research and haven't found much about pharmacological treatment of OCPD. Do you have any suggestions regarding possible medication combinations or dosages for him?
Thanks.
ANSWER:
You're correct - there's nothing in the literature. People with OCPD respond
to high doses of Prozac - usually 60-80mg daily. Things stop being a "big deal".
I have an extensive chapter on the OCPD in "Biological Unhappiness".
The hyperarousal and stress intolerance imply more than one diagnosis is going on. I
highly encourage you to look at the
screening test
I use for
my patients.
Sexual side effects are usually treatable with Wellbutrin or high doses of ginkgo. If the
generalized anxiety disorder is present, treating with BuSpar will stop the worry and can
often prevent the lack of orgasms SSRI's can cause.
