Posted by SLS on September 14, 2015, at 17:06:01
In reply to Switching from Sertaline to Luvox CR. Thoughts??, posted by scleme1 on September 14, 2015, at 11:13:01
Generally speaking, there is no better SSRI for OCD than fluvoxamine. I'm sure you know that already. I don't know if this is relevant to clinical observations, but fluvoxamine is unique among SSRIs in its potency as a sigma-1 receptor agonist. I am a little surprised that Zoloft worked well for you with respect to OCD and anxiety. I guess that just reinforces the notion that one cannot be so categorical as to where to place drugs clinically or physiologically.
I have read a few articles suggesting that fluvoxamine works for anxiety disorders, but it is not approved for this use by the U.S. FDA.
http://www.ncbi.nlm.nih.gov/pubmed/18568110
You may need to consider polypharmacy. Phidippus is pretty good with OCD. He has some personal experience with several different treatment strategies. I believe he has reported success with the use of vortioxetine (Brintellix) at a dosage of 40 mg/day.
Have you tried one of the atypical antipsychotics? 5-HT2a receptor antagonism might be helpful. Nortriptyline also does this. I don't know of anyone who has combined nortriptyline with a SSRI for OCD, but it might be worth doing a quick literature search.
http://www.ncbi.nlm.nih.gov/pubmed/9786103
Perhaps combining potent SRI with NRI would work in a manner similar to clomipramine, but without the anticholinergic side effects. Also, it may be that, because of its 5-HT2a receptor antagonism, nortriptyline confers some anxiolytic effects without needing the dopamine receptor antagonism of an antipsychotic.
As usual, I'm just thinking out loud.
At this juncture, you can either continue with sertraline and make dosage adjustments and/or add other agents, or switch from sertraline to a different treatment strategy.
It appears that fluvoxamine can produce either initial somnolence or insomnia. I don't know how persistent these side effects are. I hope they are only startup effects. I have never tried fluvoxamine.
One step at a time, I guess.
Good luck.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1082469
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