OCD A to Z: M is For Medication

I knew I wanted to write about medication as my M word, but I felt anxious about it. My path to taking medication was long and convoluted. I'm up to Part 7.5 of my medication story, as you'll see from the list of posts below. In Part 7.5, I had been off my SSRI antidepressant(pitifully low dose for OCD) for several months, and increasingly trapped in my anxiety about my body.

My incessant seeking of answers about my symptoms led to more medical tests, including a biopsy and a freak accident, after which I could barely sit or walk, and all manner of bandaging as the wounds slowly healed. I've never experienced pain like that before. Getting in and out of the car was an ordeal. Yet in the middle of this crisis, I realized I needed real help, and I found a therapist on the International OCD Foundation list, who specialized in Exposure Therapy, and made an appointment, just a week after my injury. I drove 1.5 hrs through traffic, in raw pain, and limped into the therapist's office. I was trying to sit on the couch and talk about my symptoms of OCD, while feeling like a freak.

This Exposure therapist referred me to another therapist in the practice, Leonard, who helped me change my life. I had gone back on my tiny dose of the SSRI after finding out my sister-in-law had had a heart attack at age 49, and the health anxiety was more overwhelming than my fear of medication. Leonard advised me that OCD often responds to larger doses, and with my doctor's approval, I slowly ramped up my dose of the course of a couple of months to the maximum. Leonard didn't patronize me. He didn't throw meds at me. He helped me to see that in order to do my exposures, and have some breathing room from the OCD, that a high dose could aid that. I'm still on that high dose, and in the process of slowing down my ERP therapy, as I've made tremendous progress. In the past my OCD would be agitating to get me off meds right now, because of needing to know right now if there are long term effects. I still get those thoughts, but if I go off the meds, it will be on my terms not the OCD's, and for now, the benefit of reclaiming my life is enough.

[Revisiting OCD A-Z from 2011]

Part 1: OCD and Medication Decisions
Part 2: Starting Medication while Struggling
Part 3: The Limits of Research in Medication Decisions
Part 4: My First Prescription for SSRI's
Part 5: Feeling it in the Jaw: Side Effects of Medication
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

OCD Treatment Study: For those Taking Medication but Still Having Symptoms in Philadelphia and New York

This is a study for people who are taking medication for Obsessive Compsulvise Disorder (OCD) but still have trouble with OCD symptoms. The study provides a type of Cognitive Behavioral Therapy for OCD to see whether this therapy can help people become well and then stop taking their medication.

Medication and OCD

The most commonly used treatment for obsessive compulsive disorder (OCD) is a group of medications called serotonin reuptake inhibitors (SRIs). Despite research showing that these medications help many OCD patients, a substantial number who take such medications remain symptomatic. In fact, on average patients taking SRIs experience only a 30% reduction in their OCD symptoms and most have side effects that impact their quality of life.

Another Treatment Option

Another treatment for OCD is a type of cognitive-behavioral therapy called Exposure and Response Prevention (EX/RP). EX/RP has been found effective as a stand-alone treatment for OCD and it can also further reduce OCD symptoms in patients who take medication and continue to experience OCD related distress. Not only is EX/RP effective in reducing symptoms, many patients are able to maintain their gains after therapy has stopped.

Our OCD Treatment Study

The goal of this study is to identify who benefits from adding Exposure and Response Prevention to SRI medication and to find out whether they can discontinue their SRI. Participants in the study will receive up to 25 twice-weekly sessions of EX/RP. Participants who experience a significant reduction of OCD symptoms from EX/RP will be randomly selected to either: 1) gradually discontinue their medication and begin taking a placebo (sugar) pill instead or, 2) to continue taking their medication. Participants will not know if they are taking placebo or medication. All participants will be monitored by the study psychiatrist for an additional 6 months and will receive monthly therapy sessions to help them maintain the gains made from EX/RP.

This study is being conducted in Philadelphia at the University of Pennsylvania and inNew York at Columbia University. To participate in this research, you must be able and willing to travel to either Philadelphia or New York for all study visits.

Click here to find out more about eligibility for our OCD treatment study.

Warning:People with OCD should never try to stop taking their medication without supervision by their prescribing doctor.

Center for the Treatment
and Study of Anxiety
University of Pennsylvania
3535 Market St, 6th Floor
Philadelphia, PA 19104
215-746-3327

EDITED 12/18/14
The contact info for the New York Site has changed:  (646) 774-8062 and the new email is mschwar@nyspi.columbia.edu

Pharmacological Treatment of OCD: DVD's Available of Dr. Steven Poskar's Presentation at OCDNJ

I subscribe to the newsletter of OCD New Jersey and recently they had a Dr. Steven Poskar of OCDNY as their guest speaker.

Dr. Allen Weg, VP of OCDNJ, sent out this note after the presentation about DVD's, and I thought I would pass it on, because it sounds like a useful resource: 

. . . if you were not at our meeting last night (and, actually, even if you were), and you are interested in the latest in medication options for OCD, you should consider ordering a DVD of Dr. Steven Poskar's presentation.  It was an incredibly thorough and exhaustive review of what is out there, including some of the newest avenues of research.  If interested, call OCDNJ President Ina Spero at 732-828-0099. 

Dr. Steven Poskar is a certified Diplomate in Psychiatry by the American Board of Psychiatry and Neurology. He specializes in psychopharmacology and cognitive behavioral therapy at the Spectrum Neuroscience and Treatment Institute in New York City.

Dr. Poskar is a co-founder and current Vice President of OCDNY, the NY affiliate of International OCD Foundation. He is a member of the International OCD Foundation’s Body Dysmorphic Disorder, Hoarding and Autism Spectrum Disorder Special Interest Group.

Dr., Poskar’s presentation is entitled, “Pharmacological Treatment of OCD: The very latest developments in exploring options.” This presentation is an exhaustive review of the many medication options now available for those struggling with OCD and those treating them, including the very latest information on approaching the psychopharmacological treatment of OCD, not only by targeting serotonin and dopamine sites, but glutamate abnormalities as well.

Living with Me and My OCD: An Interview for Claire's Documentary

ClaireJaneOCD on twitter is creating a documentary about the experience of having OCD, and invited me to contribute a video.  Claire and Jane are twins in the UK, who just completed running a marathon in order to bring awareness about OCD.  This is my first time recording myself!  And definitely an exposure to make it, but hopefully will be helpful to other people who struggle with OCD.

Built on Sinking Sand: The House of OCD and Health Anxiety

It was the summer of 2006 when I sank deeply into the OCD with a full scale health anxiety crisis. OCD thinking is like an elaborate structure built on sinking sand. It appears so real and solid and indisputable and all the while your life is collapsing underneath you, and the logic is built on inherently unstable ground. OCD is an entire industry of thinking with very little to do with the outside world, except for the grain of truth that it inevitably latches onto.

Even writing about this summer stirs up the OCD. Part of my compulsion to make the anxiety go away was to make detailed notes about my symptoms, in hopes that I accounted for every possible thing, so my impulse, when writing this blog post, is to include every detail. The anxiety began when I agreed to take a medication which might alleviate a symptom that I obsessed about frequently. I took the medication, and started obsessing that I was getting a bladder infection, which was another one of my health anxiety themes. After fixating on every bladder sensation, and agonizing about whether to call my doctor, I finally did and she got me in at the end of the day. It is common(though perhaps not recommended) to treat women empirically if they have bladder infection symptoms, so that's what she did--no urine test.

And that began an elaborate building of health fear, one level on top of another. Because I'd had a severe headache with one antibiotic in the past, I said I wanted a different one, and in dodging one fear I landed in another as I began to obsess about getting a yeast infection from the 2nd antibiotic, and called my doctor who prescribed meds over the phone. I was overwhelmed with a surge of anger at my doctor for not doing a urine test since I had several bladder infections that turned out not to be, and since strong feelings set off my OCD, I was on very shaky ground.

Over the next weeks the OCD was compounded and grew at an alarming rate. I went to a different gynecologist, who was near my house, who did a lab test and said I did not have a bladder infection, and gave me more meds for the supposed yeast infection. I still felt urgency in my bladder, and even more urgency in my OCD desire to know exactly what was going on in my body, and perfectionistic self-condemnation for not perfectly diagnosing myself or advocating for tests, or for calling a doctor in the first place. The OCD thoughts were all about my defectiveness, and my responsibility to make sure I didn't get a kidney infection, and the imperative that I never make a mistake, and that I would be haunted by the pain and discomfort in my body.

I was on a quest to get relief from my anxious imaginings and my fixation on painful sensations in my body. I found a new family doctor, who said if I still had bladder urgency that I probably did have an infection, and she wrote a script for antibiotics, and reluctantly did a urine test at my request, but when I panicked that I did not do the test sample correctly, she went into authoritarian mode and told me to not get myself worked up, to just calm down. Well, if I could do that, I think I would have already. . .I went and cried in my car.

So here I was trying to decide whether to take another antibiotic, without test results, and the OCD structure was growing, as I felt a surge of hyperresponsibility that if I got a kidney infection it would be all my fault, so I'd better take the antibiotic. By the end of that week, I couldn't sleep at night, and I went into the doctor on a Saturday. The doctor on call was much calmer and kinder, and she prescribed another antibiotic that would be less likely to cause insomnia, but this antibiotic wreaked havoc with my digestive system. I went back to the doctor on call who happened to have my test results, and once again it showed I didn't have a bladder infection but that I did have blood in my urine, and she wanted me to see a urologist.

By this time I was a mess. My therapist Molly was on vacation. I went to see the therapist on call, and told her how I couldn't get this right, couldn't figure out what was wrong with my body, that I needed to try harder. She sat quietly for a moment, and then said that it seemed I had been working incredibly hard to find out what was wrong, with multiple doctor visits and relentless researching on the computer. I was baffled by this. This did not make sense in my OCD world, where I was never good enough, never finished, never solved, never certain.

She wrote a few sentences on a scrap of paper, and gave it to me:

May I be filled with lovingkindness.

May I be safe from inner and outer dangers.

May I be well in body and mind.

May I be at ease and happy.

This was a glimmer from outside the windows of the house of OCD, the possibility of another way to view the world. Feeling body symptoms can be hard enough without the "inner dangers" of OCD. I was to descend further into my OCD, but I had a moment of reprieve.

*********************
Thinking about it now, this is part 7.5 of my Medication Series, since it was my first OCD crisis after ceasing to take my antidepressant.

Part 1: OCD and Medication Decisions
Part 2: Starting Medication while Struggling
Part 3: The Limits of Research in Medication Decisions
Part 4: My First Prescription for SSRI's
Part 5: Feeling it in the Jaw: Side Effects of Medication
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication

Wanting to Get Off my Medication: Part 7

I took my low dose of an SSRI antidepressant for 2 years. Doing the hard slogging of therapy with Molly, I began to discover that it was ok to do things because I wanted to do them, rather than what my parents wanted. I was driving again, going places by myself rather than always with my husband. I started making art. I emerged from years of depression and shyness, and started to believe that my life mattered.

Because I was doing so well, and starting medication had been such a battle for me, I started thinking more and more about wanting to stop taking it. I'd read studies that if OCD is treated with medication alone, there is a higher chance of relapse after stopping it, as opposed to using Exposure and Response Prevention Therapy in combination or alone. I assumed I'd had so much therapy and changed so dramatically, that I would not relapse.

What I did not realize was that my therapy with Molly, as important as it was, left much of my OCD thinking and rituals intact. OCD is sneaky and evades much of regular talk-therapy, as if shielded in a cloak of invisibility. Some of what I did with Molly was the equivalent of Exposures--she often encouraged me to experience things rather than just research them, and I faced many things I feared out of a desire to fully live my life, but other aspects of my OCD thinking were not even conscious to myself.

I began to obsess about long term effects of taking SSRI's, and soon I was exhausting myself with searches on the internet. I didn't see the danger signal that I was reverting to the searching I did trying to decide whether to take the meds at all. The uncertainty about what the long term effects might be in my life was too hard for me to cope with, and I switched to compulsively searching about how to taper my dose to avoid discontinuation symptoms. I was fatigued from all the energy I was pouring into searching, but imagined that once I stopped the medication, the obsessing would stop. Oddly enough, although I know I talked to her, I don't remember anything about what Molly said about my going off medication.

I couldn't talk to psychiatrist about this because she was gone. One day a few months before, I'd gone to an appointment and there was a For Sale sign in the front yard. She apologized for not telling me sooner she was moving. This was disconcerting. I talked to my family doctor about stopping and she agreed that if my overall anxiety was improved, I could stop the meds once the long nights of winter were over. I reduced my dose slowly over a few months, and I had no withdrawal symptoms. I was ecstatic to be off the antidepressant. It's hard for me to think about how the next few months unraveled into a health anxiety crisis, but I will write about that next time.

Related Posts
Part 1: OCD and Medication Decisions
Part 2: Starting Medication while Struggling
Part 3: The Limits of Research in Medication Decisions
Part 4: My First Prescription for SSRI's
Part 5: Feeling it in the Jaw: Side Effects of Medication
Part 6: Being on Medication & OCD Weeping
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Being on Medication for OCD & Weeping : Part 6

It was April of 2002, and finally, I was on medication for my OCD. I was at the point I never imagined I could be at. My OCD had demanded that I know I wouldn't be a different person, unalterably changed, or plagued with side effects, and somehow I had persisted and taken the antidepressant anyway, and tolerated the achy jaw, and after a few weeks, my jaw felt better, and I was in a routine of taking a blue pill at breakfast. My perfectionism guaranteed that I took it every single day. And again, anticlimatic as it was, I still felt like myself, and didn't have any other physical symptoms.

I was in the thick of dealing with some very painful memories with Molly, my therapist, and the medication did settle the anxiety long enough for me to actually face the pain, grieve and come out the other side over the course of the next couple years. I suspect the antidepressant was indeed helping my depression lift, and allowing me some room to grow. OCD is often intertwined with whatever else is going on in our lives, an is often comorbid with despression. As much as I advocate for Exposure Therapy for OCD, that doesn't mean everything else will be solved by it, and these other issues can make the OCD worse or treatment harder to do.

For me, just about any strong emotion would trigger my obsessing. I was scared of feelings, and before I could let myself experience them, my OCD was all over it, analyzing and debating and getting me stuck in the middle of the pain, which is what I had been trying to avoid in the first place. The low dose of a SSRI allowed me to go deeper into the pain, which on the face of it hardly sounds like a reward for taking it! But I had become numbed with fleeing from anything sad, and then overwhelmed by a compulsive desire to "solve it all now" by ruminating on every sad thing, and the medication seemed to make it possible to let the pain ebb and flow, and let in the possibility of joy as well.

While in the midst of this waking up to feelings and to my own life, the obsessing about SSRI's took on a new form. I started obsessing about the long term effects of being on medication. My health anxiety was still operating in the background. It wasn't a roar, more like a dull hum. Molly wasn't treating my health anxiety. We had enough going on with just my depression and grief, and she didn't really understand the extent of my obsessive thinking. I'd been that way for so long, it seemed an intrinsic part of me, and unchangeable. I feel extremely grateful that Molly persevered with me and all the painful history I brought with me, my distrust of just about anyone's love, my fear of being worthless and abandoned. This gratitude coexists with anger that she wasn't competent to deal with OCD as well. The ability to let these two feelings be there at the same time was hard won.

Related Posts:
Part 1: OCD and Medication Decisions
Part 2: Starting Medication while Struggling
Part 3: The Limits of Research in Medication Decisions
Part 4: My First Prescription for SSRI's
Part 5: Feeling it in the Jaw: Side Effects of Medication
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety
Talking to OCD: The Hazards of Talk Therapy

Part 5: Feeling it in the jaw: Side Effects of Medication and OCD

It takes courage to start medication if you have health anxiety. At the time I didn't feel brave, but I had the good fortune of a husband who told me I was brave. There was some relief in making the decision to start an SSRI, rather than going back and forth indecisively, but in OCD fashion, a whole new area of opened up for obsessing. The first week or two on half a pill was anti-climactic, and oddly disappointing since the flip side of fearing instant bad changes is the hope for instant good changes.

My psychiatrist moved my dose up to a whole pill, and one morning I noticed my jaw felt tight. I'd had jaw pain in the past, and this was a "health anxiety hot spot" for me. I became intensely vigilant of every sensation in my jaw, and kept checking it, asking myself if it still hurt, which escalated my panic, because yes, it still hurt. I did a search in a medical database, and found a handful of case reports of jaw pain as a side effect of ssri's. My OCD was all over this--"How do I know for sure this is a side effect? Am I being oversensitive? How do I figure this out?" Finally I took the plunge and called my psychiatrist, no small feat since phone calls were hard for me.

She was at a conference, but returned my call that evening. Her compassion and thoughtful response was incredibly helpful. She asked me about the information I'd found, and said to send her the abstracts, because she'd like to read them. Although she couldn't say for certain if it was a result of the medication, she advised going back down to half a pill for a week or so. Her ability to respond with a middle path was a great model for me.

The medication was helping, so I was willing to stay with it and see if the symptoms abated. It's extremely challenging to practice trial and error and keep an open mind when you are suffering. The human desire is to find a solution NOW. Backing down the the dose before trying again with a whole pill worked. The jaw pain eased, especially after I took basic self-care actions. I got so stuck in checking the pain at first, and being afraid I was "crazy" that I didn't even think of laying off crunchy stuff, or avoiding biting into things.

Related Posts:
Part 1: OCD and Medication Decisions
Part 2: Starting Medication while Struggling
Part 3: The Limits of Research in Medication Decisions
Part 4: My First Prescription for SSRI's
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Part 4: My First Prescription for SSRI Medication

I last left my story of medication for OCD with Dr. Celexa in 2001, and his confidence that a med would fix any side effects I might have if I started on Celexa. Shortly after, I began researching whether Celexa was the right medication. I was terrified of making a mistake. In the midst of this, my therapist, Molly, started a session by saying, "This is going to be hard for both of us. I need to have brain surgery, and will be out for 6 weeks." OCD doesn't leave a lot of room for learning how to cope with the chaos of life. Yeah, I researched her surgery, and that anesthetized the anxiety for a fleeting moment. I had spent years researching things, and by the time I surfaced from whatever the current search was, life had moved on without me.

Nobody wants their therapist to have brain surgery. It is a scary, scary thing. Molly came through the surgery, and left me a groggy, anesthesia and pain killer influenced message on my voicemail that she was ok. I was still re-reading all the entries in the phonebook under "Psychiatrist" and realized there was one I hadn't called because she was farther away, but I had started driving again, and it occurred to me that I could get there. Dr. S. actually called me back, and could see me within a week. She had her office at her house, a McMansion on a cul-de-sac.

I sat on her leather couch, going over my questions in my mind, and as if this would somehow compel me to ask them, rather than mentally rehearse them in hopes of perfection, which would never come. She listened to my fears about side effects, and gave it to me straight. She said that she liked Zoloft, that maybe this was because the drug rep came by more often than other ones did, but she had clients who did well on it, and it had a short half-life, so if I had side effects, I could stop the drug and have it out of my system relatively quickly--not as abruptly as Paxil, but not as dragged out as Prozac.

Dr. S. said she'd start me on a low dose, 25 mg, and slowly titrate it up. I had done repeated searches on the concept of titration, so it was a relief to hear someone actually discuss it, though that didn't last long, since the OCD can always find a new concern. She gave me the prescription, on a slip of patterned blue paper, like the inside of a security envelope, and I went to the drugstore to have it filled. I bought a little guillotine to cut the pills in half. This was April of 2002. More to come.

Related Posts

Part 1: OCD and Medication Decisions
Part 2: Starting Medication While Struggling
Part 3:The Limits of Research in Making a Decision
Part5: Feeling in the Jaw: Side effects
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Part 3: The Limits of Research in Making a Decision about Medication

It's 2002, and the psychiatrist who put me on his waiting list finally called to schedule an appointment. I sat in a leather chair, feeling like a willow trembling with the slightest breeze. He was a soft spoken man in his 50's, and he paused after I spoke as if to absorb what I said before responding. He concurred that I had a diagnosis of OCD, and felt medication could help me, and that perhaps after a year or so, my mind would "reset" itself and I would be able to taper off.

He proposed Celexa because it was new and not supposed to have sexual side effects. OCD thinking had seriously stunted my ability to approach anything near intimacy with my husband, and we had just started making some progress because of working my therapist, who I will call Molly. I was terrified of sexual side effects, and this was a major obstacle to my taking medication. I'd read numerous articles on the subject from the medical literature, plus enough posts on internet bulletin boards to fuel up my obsessing to the flammable point.

His assurance to me was that if I did have sexual side effects, he would put me on another drug, Wellbutrin, and this would correct the problem. As much as I liked this doctor, his solution was like something from a farce. Take one woman who is very afraid of taking medication, and tell her that a drug will solve any problems created by the first drug. . .

But I still knew that I couldn't go on the way I had been, with rituals consuming a lot of my time and energy. I told him I would need to think about it. I believe I did something actual thinking at the time. This is an important distinction. Obsessing and compulsively looking up medical articles is not the same thing as thinking about something, or problem-solving.

I'd read enough to know that some people were helped by SSRI antidepressants, and that the only way to know if they would help me was to try one. This is incredibly difficult for someone who hoards information to accept, that some things have to be experienced rather than researched, that sometimes you need to make a decision, and you will never have enough information to make a perfect decision. But I was on my way to making a decision.

Related Posts:
Part 1: OCD and Medication Decisions
Part 2: Starting Medication While Struggling
Part 4: My First Prescription for SSRI's
Part5: Feeling in the Jaw: Side effects
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Part 2: Starting Medication while Struggling with OCD and Insurance

I am fortunate to have a job with health insurance coverage, but "behavioral health" was only grudgingly included in any form, complete with a limited network of therapists, and no psychiatrists. I already had a therapist when I started considering medication, but of the sparse list of psychiatrists in my area, many didn't want to do "medication management" if they couldn't also counsel me in some way, others weren't taking new patients, or didn't return my calls. One called me back and had a 3 month waiting list, but at least was willing to put me on it.

Willingness to take medication was already tenuous for me at best, and the maneuvering required by my OCD and social anxiety was a serious challenge to following through. It's hard to cope with:

1)I really don't want to do this.
2)It's going to take quite a bit of effort to do what I don't want to do.
3)OCD is having a field day with all the uncertainty, cultural debates about overmedication, and an intense fear of trial and error.

The only other psychiatrist I'd ever seen was 7 years previously, a requirement by a previous insurance company that to get any talk therapy I had to see a psychiatrist first. He prefaced his diagnosis of generalized anxiety disorder with "You're not going to like this, but I think you need to consider taking medication." At the time, SSRI's weren't generally being used for anxiety disorders or anything else for that matter, and the drug he suggested was Buspar, which got mediocre reviews.

I felt defensive, hearing in his tone that "psych patients don't want to take their psych meds", that he knew me thoroughly after just 45 minutes, and I was a stereotype. At that point, I didn't drive, and he gave me a referral to a therapist remote from where I lived, and only accessible by car, which seemed like sending me to another country altogether.

OCD as a disorder is very adept at latching onto whatever is at hand, and waylaying you with a grain of truth, just enough truth to make itself plausible, needed, useful. It is wise to be an informed consumer, so I felt justified in compulsively reading about Buspar, to the point of exhaustion. OCD will demand an answer in advance to the question: Will this work for me? The psychiatrist was patronizing, and that sucked, and OCD was more than willing to say "Don't do anything. Just keep obsessing."

Ironically, when I was considering medication 7 years later, I was fixated on getting it from a psychiatrist because I had compulsively researched the topic, and was afraid that my family doctor wouldn't choose the right medication or dose.

Related Posts:
Part 1: OCD and Medication Decisions
Part 3: The Limits of Research in Medication Decisions
Part 4: My First Prescription for SSRI's
Part5: Feeling in the Jaw: Side effects
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Part 1: OCD and Medication Decisions: SSRI Antidepressants

I've been taking the maximum dose of an SSRI Antidepressant for the past 3 years. Before that I was on the lowest dose of an SSRI for 2 years. This was one of the most excruciating decisions I've ever made, and somehow I managed to make it in the midst of a hurricane of OCD symptoms. That is an act of grace! When my previous therapist suggested the possibility of an SSRI, obsessing went to tidal wave. I already had only a scrap of dry land to stand on in the swirling waters of my mind, which is why the therapist proposed medication. My intense revulsion and fear led her to suggest acupuncture, which was not an object of my OCD anxiety.

It took me a year to choose to take medication. A year of compulsive research, and increasingly time-consuming mental rituals of trying to figure out whether I should take them, which one would work, and battling my fear of making phone calls in order to find a psychiatrist who would be able to prescribe them for me. So let's recap:

1)I have health anxiety, so I was petrified by the possibility of side effects
2)I was prone to existential OCD, and ruminated on whether I would no longer be myself if I took medication. I wanted to know how I would feel without a constant barrage of OCD, but I couldn't actually replicate it in my mind, which totally freaked me out.
3)I I wanted absolute certainty, in advance, that I would get on the right medicine, at the right dose, and that I wasn't crazy to consider taking SSRI's.
4)I had severe OCD issues with making decisions, and the decision points kept branching off infinitely--should I take the med? Who should I get the med from? Which med? Which dose?
5)I felt that my therapist was overwhelmed by my obsessing, and after my initial panic when she suggested meds, she didn't know how to help me make a decision.

Here was the bedrock:
Obsessing about medication was leaving me little time to do anything else with my life.

I had the revelation that it was possible that taking medication would stop the obsessing about medication.

I was full of fury about this. I hated this. I felt trapped. I couldn't go on as I was. I was exhausted. But what if taking medication meant I was unredeemable? That I was wrong? I had intense dread, as if taking medication was the equivalent to choosing to go to hell. I don't mean this in any specific theological way, but rather sheer terror.

It's hard to think back to this time. I found the courage to take a chance on medication, which calmed the constant feedback loop of OCD enough to give me some breathing room, and then later, to do Exposure and Response Prevention Therapy. I'll write more about this experience. It's more than fits in one post. But if you are struggling with a decision about medication, know that my heart goes out to you.

Related Posts:
Part 2: Starting Medication While Struggling
Part 3:The Limits of Research in Making a Decision
Part 4: My First Prescription for SSRI's
Part5: Feeling in the Jaw: Side effects
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety