Seeking Guidance on OCD Treatment and Medication Concerns

I need advice?

Dear Dr.
Dai,
I have a few questions regarding my condition: obsessive-compulsive disorder (OCD) and depression.
1.
With the upcoming university entrance exams, the doctor suggested that I take 0.25 mg of Anxiolytic.
However, I found in the medication leaflet that it may cause irreversible side effects such as impaired judgment and tardive dyskinesia.
I'm unsure whether I should take this medication, as the doctor mentioned it is my decision.
I would like to hear your advice on this matter.
2.
I have heard that not taking medication for OCD can lead to brain atrophy, while medication can promote neurogenesis.
Is this accurate? Personally, I feel like I have lost my sense of purpose while on medication.
Is this more likely due to my own issues or the medication?
3.
Recently, I have been feeling quite terrible.
I spent a significant amount of money for my family to retake classes, but I often have to take leave due to poor performance (this is my second year).
I feel like it's a waste of money.
Seeing my classmates study hard adds to my stress.
I used to aim for my first-choice university and gifted classes, but now my grades are quite disappointing.
I understand that grades are not everything, but it’s hard not to care about others' opinions.
The medication has many side effects, and I really want to stop taking it.
I feel overwhelmed and stressed.
What should I do?
I apologize for the lengthy message, and I appreciate your time in reading and responding.

A, 10~19 year old female. Ask Date: 2021/12/08

Dr. Dai Wanxiang reply Psychiatry

Hello, regarding the questions you raised, here are the responses:
1.
The concerns you mentioned about the side effects of Anlifu (Amisulpride) related to sedation and tardive dyskinesia: some individuals may experience drowsiness after taking it, which can affect attention and cognitive judgment.
If this occurs, taking the medication before bedtime may help manage this side effect.
Since Anlifu is a new generation antipsychotic, the likelihood of acute or tardive movement disorders is low.
If the benefits of taking the medication outweigh the risks, it should be fine to continue.
However, if you experience any adverse effects, it is important to discuss them with your physician promptly.
Your treating physician is most familiar with your condition, so if you have any doubts about the need for Anlifu, it is advisable to discuss it with them, including topics such as indications and side effects.
2.
Indeed, research has indicated that certain brain regions in patients with obsessive-compulsive disorder (OCD) may be smaller in volume compared to normal controls.
After taking medication, you may find that you are less preoccupied with certain thoughts (such as original obsessive ideas), which is likely a part of the therapeutic effect.
However, if you experience feelings of aimlessness, it is important to assess whether you are also experiencing symptoms such as low mood, loss of interest, negative thoughts, or insomnia, as this may indicate the possibility of comorbid depression.
I recommend discussing this with your treating physician.
3.
It is understandable to feel a sense of decline in academic performance, especially when compounded by the effects of mental illness, medication side effects, family expectations, and peer pressure.
Adjusting to these challenges can be very difficult.
Finding ways to relieve stress and organize your emotions is certainly a challenging task.
Talking with trusted family members and friends, cultivating leisure interests, and maintaining a regular exercise routine can all be beneficial for stress relief.
If you seek more professional advice, you can also discuss with your physician about medication adjustments, psychological therapy, and utilizing a multifaceted approach to support you through this difficult time.
Wishing you peace and well-being.

Reply Date: 2021/12/08

More Info

Hello,
Thank you for reaching out with your concerns regarding your treatment for Obsessive-Compulsive Disorder (OCD) and the medications you are considering. It’s understandable to feel overwhelmed, especially with the pressures of upcoming exams and the expectations you have for yourself. Let’s address your questions one by one.

1. Concerns about Anxiolytic Medication (Anlifu): It’s true that medications like Anlifu (which contains a benzodiazepine) can have side effects, including cognitive impairment and the risk of tardive dyskinesia, which can be irreversible. However, it’s important to weigh these potential risks against the benefits of managing your OCD symptoms, especially during a stressful time like exam preparation. If your doctor has suggested this medication, it may be because they believe the benefits outweigh the risks for your specific situation. It’s crucial to have an open dialogue with your doctor about your concerns. If you feel uncomfortable taking the medication, discuss alternative options or adjustments to your treatment plan.

2. Impact of Medication on Brain Health: The notion that not treating OCD can lead to brain atrophy is a concern that has been discussed in some studies. Chronic stress and untreated mental health conditions can indeed affect brain structure and function. However, the relationship between medication and neurogenesis (the growth of new neurons) is complex. While some studies suggest that certain antidepressants can promote neurogenesis, it’s essential to remember that medication is just one part of a comprehensive treatment plan. Therapy, particularly Cognitive Behavioral Therapy (CBT), is also highly effective for OCD and can help you develop coping strategies without the need for medication. If you feel that the medication is making you lose sight of your goals, it may be worth discussing this with your healthcare provider to explore other therapeutic options.

3. Feelings of Pressure and Guilt: It’s completely normal to feel pressure, especially when you perceive that you are not meeting your own or others’ expectations. The financial investment in your education can add to this stress, but it’s important to remember that your mental health is paramount. Taking care of your mental well-being should be your priority. If you feel that the medication is contributing to feelings of hopelessness or a lack of direction, it’s essential to communicate this with your doctor. They may suggest adjusting your dosage or trying a different medication. Additionally, consider seeking support from a therapist who specializes in OCD or anxiety disorders. They can provide you with coping strategies and help you navigate these feelings of pressure and guilt.

In summary, it’s crucial to have open communication with your healthcare provider about your concerns regarding medication and its effects on your mental health. Remember that you are not alone in this journey, and seeking support from professionals can make a significant difference. It’s also important to practice self-compassion and recognize that your worth is not solely determined by your academic performance.
Take care, and I wish you the best in managing your OCD and navigating this challenging time.

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