Obsessive Compulsive Disorder (OCD) part 10

At a minimum, six months. If a person has been very ill and it has been a real battle to get them better, I usually advise they take medications for 12-18 months. Either way, we try to discontinue medications in the summer when school is out. When we discontinue medications a couple of things can happen:

The person does just as well off medications as on.  That is the best sign.   Overall, about 50% of people will be able to do that.

The child gets worse over the next few weeks.  In this case we put the child back on medications for at least another year.

Sometimes a child will do well off medications for a few months, and then have a worsening of OCD again.   We then restart the medications for another year or so and then try discontinuing again.

Of the children I see, that is the more severely ill, at least 50% can not get off the medications without relapsing.  There is no danger in this, as these drugs do not have any long term side effects.

These drugs are really in two families that are quite different.   Clomipramine is one family and all the others are in another.

This drug can have a lot of side effects.  It was for this reason, in part, that researchers started using the other drugs mentioned above.  The side effects are of two types , nuisance and serious.

This drug can frequently can cause dry mouth, blurred vision, tremor, constipation, extra sweating, weight gain, rapid pulse, sedation and a rash.  Some people will have none of these, some will have many.  You don't know until you try which is why you start low, go slow and monitor (see above) Most children will have some side effects to this drug.

If there are high levels of this drug in your body, it can cause unusual and sometimes dangerous heart rhythms.  It can cause seizures in some children.  It is quite lethal in overdose.

This is not a first choice drug for OCD. However, some times a child will not respond to other drugs.  Sometimes a person tolerates this very well.  Sometimes the side effects are a problem, but the child is so much better it is worth it.

This drug can effect the heart.  That means some special things are done.  Before the drug is started an EKG is obtained.  Then the drug is started at a very small dose and slowly increased.  Then another EKG is checked.  Once those results are back, then the drug dose is increased, if they are normal.  As the drug dose is increased, the ECG is checked again.  Besides this, on every visit the I check the weight, blood pressure, and pulse.  I also check for a tremor.

Robin weighs 110 lbs., which is about 50kg.  these drugs are usually given by milligrams per kilogram.  Robin had been tried on behavior treatment plus two other drugs which did not work.  So now she was starting on Clomipramine.  First we got an EKG and it was normal.  The drug was started at 25 mg a day.  Over the next week we increased it by 25 mg every four days until she was taking 100mg a day.  Then we checked an EKG.  When I saw her, I checked her pulse and blood pressure.  It took two weeks to get the EKGback from the lab so she just kept taking this dose.  She had only a little dry mouth and bright lights bothered her a little (this drug can make your pupils bigger).  the EKG came back and was normal.  We could have increased it further, but Robin was really starting to improve.  She never had any serious side effects and her OCD basically disappeared.

All of these drugs have been tested in OCD in children.  However since Celexa is new, there is only one study of this medication in the literature (3) These drugs all have the same side effects.  However one person might tolerate one drug very well but not another.  Likewise one might work, but not another.

Insomnia, nausea, vomiting, diarrhea, cramps, headaches, occasionally sedation, tremor, weight loss.  Most children have very few side effects on these drugs.  Almost everyone can find one in this family of four that they tolerate.

Severe restlessness, agitation, decreased interest in sex, no orgasms, erection problems.

The drugs in this family can change how much of other medicines get into your blood stream.  Other drugs can also change the amount of these SRI medications in your blood stream.  What can happen?  Here are the possibilities:

If you start taking a drug that interacts with the SRI, the amount of the SRI in your blood could go up enough to give you more severe side effects.

If you start taking a drug that interacts with the SRI, the amount of the SRI in your blood could go down and you could become more psychiatrically ill again.

The SRI can result in another medication going up in your system, too.  If you were taking other drugs while you were on an SRI, those other drugs might give you more side effects.

Unfortunately, the SRIs are not similar in this regard.  Each one has different medications which it interacts with.

Tina is 11.  She has been taking Prozac now for about a month and she is a lot better.  But she has the flu which is going around and so her mom went to the drug store and got some cough syrup.  Tina took the cough syrup and got very, very confused.  Her mom (already nervous) was worried that Tina was getting meningitis.  She took her to the hospital and was glad to find out that it was a drug interaction between dextromethopham, the main ingredient in cough syrup, and Prozac.  Still, it took Tina about a week to get over this.