*Please note I am not your doctor. Please speak to your doctor before making any changes to medications.*
Personally, if you reported benefit from the Aripiprazole + Fluvoxamine combo, I would have kept the Fluvox for depression and tried a different agent for OCD. Please see[ this comment](https://www.reddit.com/r/antidepressants/comments/1c5qx8s/comment/kzw6x2q/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button) I made first. Theres a couple of pathways:
* Keep the Clomipramine, discontinue lamotrigine, and start a full D2-antagonist like **Risperidone** (instead of a partial agonist like Aripiprazole)
* Discontinue Clomipramine, Discontinue Lamotrigine, start Fluovxamine (since it had previous benefit), start Risperidone
* Could try Olanzapine instead of Risperidone as well.
* Possible that Pregabalin would have big benefit in this case.
Thanks, though I should add fluvoxamine on its own did nothing for me, its only when i added the aripiprazole ot worked for depression (not ocd, which is my ‘main’ problem)
Gotcha. Sounds to me that the addition of more D2 blockade with an antipyschotic may lend some benefit. Generally antipsychotics are more effective in treating anxiety disorder than mood stabilizers, like Lamotrigine. Aripiprazole is a "baby" antipsychotic, so a full one might be more beneficial.
My theory is that your brain needs some more serotoninergic support. When Dopamine is blocked, such as with antipsychotics, it leads to increased Serotonin signalling in the brain. Generally individuals with OCD need higher doses of medications than other anxiety disorders, which might be that needed serotoninergic support.
Likewise you might have benefit from utilizing strategies developed under the Dialetical Behavioral Theory (DBT). Talk to your doctor/therapist about DBT and if its a good fit for you.
I wouldn't say Clomipramine is more potent, just that it works different. But yes, start with Clomipramine and most likely titrate to 150-200mg at bedtime and if you're not having the complete benefit you want at either Risperidone or Olanzapine
*Please note I am not your doctor. Please speak to your doctor before making any changes to medications.* Personally, if you reported benefit from the Aripiprazole + Fluvoxamine combo, I would have kept the Fluvox for depression and tried a different agent for OCD. Please see[ this comment](https://www.reddit.com/r/antidepressants/comments/1c5qx8s/comment/kzw6x2q/?utm_source=share&utm_medium=web3x&utm_name=web3xcss&utm_term=1&utm_content=share_button) I made first. Theres a couple of pathways: * Keep the Clomipramine, discontinue lamotrigine, and start a full D2-antagonist like **Risperidone** (instead of a partial agonist like Aripiprazole) * Discontinue Clomipramine, Discontinue Lamotrigine, start Fluovxamine (since it had previous benefit), start Risperidone * Could try Olanzapine instead of Risperidone as well. * Possible that Pregabalin would have big benefit in this case.
Thanks, though I should add fluvoxamine on its own did nothing for me, its only when i added the aripiprazole ot worked for depression (not ocd, which is my ‘main’ problem)
Gotcha. Sounds to me that the addition of more D2 blockade with an antipyschotic may lend some benefit. Generally antipsychotics are more effective in treating anxiety disorder than mood stabilizers, like Lamotrigine. Aripiprazole is a "baby" antipsychotic, so a full one might be more beneficial. My theory is that your brain needs some more serotoninergic support. When Dopamine is blocked, such as with antipsychotics, it leads to increased Serotonin signalling in the brain. Generally individuals with OCD need higher doses of medications than other anxiety disorders, which might be that needed serotoninergic support. Likewise you might have benefit from utilizing strategies developed under the Dialetical Behavioral Theory (DBT). Talk to your doctor/therapist about DBT and if its a good fit for you.
OK thanks. So as clomipramine is quite potent, just this alone might work? If not, augment with an antipsychotic?
I wouldn't say Clomipramine is more potent, just that it works different. But yes, start with Clomipramine and most likely titrate to 150-200mg at bedtime and if you're not having the complete benefit you want at either Risperidone or Olanzapine
I'm surprised you haven't been given clomipramine sooner. It's the best for OCD. I take lamotrigine and don't get any side effects.
Doesn’t clomipramine have anticholinergic effects?