Once OCD is diagnosed, then the first step is to use medication. Although the cause of OCD is still unknown, some studies have found that there is a biological aspect to the onset of OCD, and like depression, an imbalance of neurotransmitters in the brain is an important cause of the onset of OCD.
Current research has found that.
① Insufficient 5-HT in the brain
(ii) elevated DA
(iii) elevated glutamate
Antidepressant and anti-OCD drugs can act on these neurotransmitters to normalize the neurotransmitter metabolism in the brain, thus improving OCD symptoms.
The important neurotransmitters are DA (dopamine), NE (norepinephrine), 5-HT (5hydroxytryptamine), GABA (aminobutyric acid), glutamate and so on.
5-HT, NE and other neurotransmitters and depression, anxiety, obsessive-compulsive disorder have a close relationship, so the current anti-OCD drugs are antidepressants, and antidepressants can often treat anxiety, some antipsychotics can also treat depression, obsessive-compulsive, all because these drugs can act on the brain 5-HT, NE and other neurotransmitters, we can also understand why Antidepressants can be used to treat OCD and antipsychotics can be used to treat OCD, because the 5-HT neurotransmitters are closely related to the occurrence of depression, obsessive-compulsive and anxiety symptoms. The real cause of OCD will have to depend on scientific development before it can finally be researched, but as things stand now, anti-OCD medications still have good efficacy for OCD.
The principles of anti-compulsive drug therapy.
1, a long time principle: a sufficient amount of anti-compulsive drug treatment should be at least 3 months, some patients need a longer period of time, in order to be considered a course of treatment to end, in order to assess the effectiveness, can not eat a 2-3 months to assess the effectiveness of the decision to change the drug, this is because the treatment of obsessive-compulsive disorder is slow to take effect, and depression, unlike depression, depression can take 2 months to assess the effectiveness of the treatment plan to adjust the treatment, obsessive-compulsive disorder at least 4-6 months to It takes at least 4-6 months to do so.
2, the principle of adequate dose: anti-compulsive drug therapy, the dose is generally larger, sometimes the highest dose stated in the instructions, this is because the efficacy of low dose is very bad, to apply a larger dose, of course, each patient’s situation is different, the specific dose of medication to specific analysis, but in general, anti-compulsive treatment drug dose is on the large side.
3, maintenance time to be long: the largest dose of anti-OCD drugs to achieve better results, this dose is generally recommended to maintain about 6 months, and then consider reducing the dose to maintain 2-3 years.
4, with the symptoms, let nature take its course: the complete disappearance of obsessive-compulsive symptoms is more difficult, patients and families should accept the symptoms of obsessive-compulsive symptoms, with the symptoms to live and learn, let nature take its course is the core of psychotherapy for the treatment of OCD: Morita treatment, the details of which you can buy books on Morita treatment read closely and insist on doing.
First-line medication for OCD.
Currently, the first drugs I choose are: SSRI-type drugs (5-HT reuptake inhibitors).
1. Lanzai: I generally prefer this drug for OCD, and the common dosage is 150-300mg a day, which can be taken once at night. Although there are five SSRI drugs, but these drugs are not the same in terms of efficacy, LanShi I personally used in the treatment of OCD, the application of more, personal experience of anti-OCD effect is still good, the refractory OCD also has a better effect, with this drug on the σ receptor effect is stronger related.
2, paroxetine: trade names are selate, Leyou. This drug is used for anti-compulsive words, the common dose is 30-60mg daily, can be taken once orally, this drug anti-anxiety effect is very good, anti-compulsive I use more, the effect is also good.
3, fluoxetine: the trade name has Prozac, Youk, etc.. Used for anti-compulsive words, the common dose is 40-60mg per day, can be taken once orally, the drug is the first choice for the treatment of bulimia, anorexia, for anti-compulsive effect is also good.
4, sertraline: the side effects of the drug is relatively small, is the drug of choice for children’s depression, for the elderly, teenage OCD is the drug of choice, the common dose is 150-300mg a day, can be taken once orally. As for the SSRI class of citalopram and escitalopram, I use it less for anti-compulsive treatment, and the lack of experience will not be introduced.
Second-line pharmacological treatment of OCD.
1, chlorpromazine: also known as clomipramine, is a tricyclic antidepressant, is an old drug, the old drug does not mean that the efficacy is not good, on the contrary, the drug anti-compulsive effect is very good, commonly used dose 150-300mg, the problem is that the drug side effects are large, especially in large doses, the side effects are more obvious. In the current emphasis on drug safety premise, the use of the drug is less and less.
2, venlafaxine, mirtazapine, citalopram and other drugs.
The third line of medication for OCD. Third-line medications can be understood as booster agents. For refractory OCD, the combination of booster agents can sometimes have some better results. Generally are antipsychotic drugs, note: the addition of synergists should be done under the guidance and consent of the doctor, after all, the side effects of this class of drugs are relatively large.
1, aripiprazole: commonly used dose of 5-15mg a day, once or twice orally, from the clinical point of view of some patients after the addition of aripiprazole effect is very good, of course, not suitable for all patients with OCD, as a way to try.
2, olanzapine: commonly used dose of 5-10mg a day, 1 time orally, from the literature and clinical practice, the addition of olanzapine, or effective for some patients with OCD.
3.Risperidone: commonly used dose of 1-2mg a day, 1 time orally, some patients have effect.
4, quetiapine: commonly used dose of 200-400mg a day, 1 oral, some patients have the effect.
Treatment of refractory obsessive-compulsive disorder.
Refractory obsessive-compulsive disorder is after chlorpromazine and at least one SSRI drugs of independent full amount of full course of treatment, did not obtain satisfactory results.
Generally it is necessary to rely on a combination of medications to achieve better results, and the specific combination can only be determined by taking into account the different clinical manifestations of each patient. In general: the combination of anti-OCD drugs and potentiators, the combination of first-line drugs and second-line drugs, the combination of different anti-OCD drugs.