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Discussion Starter · #1 ·
I have been on Lexapro since November. It really isn't doing much for my OCD, though I have seen some slight improvement with my anxiety. I am currently on 20mg, and I am assuming that I need a higher dose for the OCD. Unfortunately, with Lexapro, one of the main problems I am having is fatigue. I need a lot more sleep than usual, and I always feel kind of tired. I can't even get out of bed for my 8 am class. My doctor recommended lowering the dose (which I don't think will do anything, b/c I felt the same way on 10mg) or changing to a different SSRI.

Can anyone give me a possible suggestion on which med to try? I suppose any SSRI could be effective for an anxiety/OCD combination.

I appreciate the help!
 

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You may combine the Lexapro with a low dose of Wellbutrin XL to get more energy and have a synergistic AD effect. If that helps perfectly, then you could ask your Pdoc to up the dose of the Lexapro as OCD-patients often need higher doses. You could also change to Zoloft or Effexor XR.
 

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Discussion Starter · #3 ·
My doctor suggested that I try Zoloft or Prozac (not really sure why he chose these two). I'm not really sure which one I should choose first. He had also mentioned trying an SNRI, but he didn't think I would see any added benefit from it.

Any suggestions?
 

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My doctor suggested that I try Zoloft or Prozac (not really sure why he chose these two).
Prozac is supposed to be the most stimulating of the SSRIs, so that may be your doc's logic there since you complain of fatigue.

Zoloft, from the trial data I've read, can go either way -- with some patients complaining of fatigue and others complaining of over-stimulation like insomnia (with both problems coming in at about twice the rate as placebo). Interesting how the same drug can have the exact opposite effects on different people, isn't it?

Your doc might well have simply picked these SSRIs at random. After all, there are I think only 6 SSRIs on the market. You've effectively already tried two of them with Lexapro, since Celexa is substantially the same given that it's active isomer is Lexapro.
 

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Both Zoloft and Prozac were stimulating for me, but Zoloft really pushed up my anxiety levels. Currently I'm on Celexa and I also have the sedation effect, but as Medline mentioned, I also take Wellbutrin and it seems to balance things out.
 

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Celexa/Lexapro + Wellbutrin XL is a great combo IMHO.
 

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Discussion Starter · #8 ·
I wonder why my doctor has never suggested adding Wellbutrin? He did mention Provigil. The only reason I'd be afraid to try Wellbutrin is because of the possibility of it lowering the seizure threshold. Is that something I should be concerned about?
 

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If you have no epilepsy or other state which lowers the seizure threshold (eg. acute sedative or alcohol withdrawal) and take the normal dosage (<= 450mg / day) then this is no problem at all. Provigil is a good idea too, but more expensive and it's not an AD.
 

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Provigil is indeed expensive at $10+ per pill. So only for those with really good insurance or money to burn on what is only a mildly stimulating drug.

As for Wellbutrin, today I took my final dose after 80 days. I officially declare it a sugar pill. And it didn't give me a seizure even at 450 mg a day. I recall reading that when it first hit the market back in the 1980s the recommended dose was 400-600 mg and it was soon pulled from the market due to seizures. It was reintroduced later with lower recommended levels of 300 as a typical dose and 450 mg max to limit the risk of seizure which I believe only happens in 1 to 4 patients per thousand who use it.
 

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My doctor suggested that I try Zoloft or Prozac (not really sure why he chose these two). I'm not really sure which one I should choose first. He had also mentioned trying an SNRI, but he didn't think I would see any added benefit from it.

Any suggestions?
Those would be what I would try first. I also take lexapro and deal with the mild sedation. Its weird in that it makes it a lot easier to stay up for longer periods of time but then I sleep forever and always feel sort of tired (I can easily sleep 24 hours on lexapro).
 

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I have been on ritalin now for 5 years. Got diagnosed when I was 17. I started with 20mg and now I'm at 60mg for the last 2 1/2 years. I was on celexa 8 months ago (my second antidepressant other was mirtazapine) and found celexa to make me alot more anxious, nauseous and introverted. It made me alot more anxious when I took my ritalin and I gave celexa 5 months but I didn't notice much at all..a bit of decreased social anxiety but heightened generalized anxiety. I started with 10mg and up to 60mg and everydose was terrible. Turned me off from ssri's. I started on clonazepam 3mg a day with my ritalin and got off the celexa. I had social anxiety and any other anxiety relieved but the clonazepam made me feel groggy and kinda depressed and down. I read about zoloft for social anxiety and decided to try it. I am on week 2 on 50mg and my mood is defeinetly helped, my anxiety is alot better (it really calms me), is very relaxing with my ritalin and I only take 2mg of clonazepam now. I find zoloft doesn't give me a fake happy feeling. It just calms me and makes me have a feeling of self worth. Those two things alone have made zoloft good so far for me. No sexual side effects and it helps me be more sociable. I still take a clonazepam but the zoloft effects are getting better so I might be getting off the clonazepam in the future. Also zoloft has dopamine boosting effects I can feel that augment my ritalin. The only antidepressant I think that won't affect cognition (which is bad in ADHD and I have really bad ADHD)
 
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