Q: I am 57 years old male suffering from obsessive compulsive disorder (OCD) of self suspicious along with anxiety under cycle of depression for the past 30 years. I have taken Fluvoxamine, Etirest and Risperidone, but the problem remains unchanged. What treatment should I undergo for persistent anxiety and depression?

A:You have listed certain psychiatric issues since last 30 years. May I suggest a detailed psychiatric evaluation as at times certain psychiatric symptoms can be seen across diagnoses? Management including medications shall depend on the diagnosis and the predominant symptoms.

You have mentioned names of 3 medications. All three belong to different class i.e. SSRI antidepressant - anti-obsessional (Fluvoxamine); anti-dopaminergic (Risperidone); and anti-anxiety (Etizolam). You have not mentioned the dose of Fluvoxamine. It is known that for obsessions, higher doses (as per guidelines) of SSRIs (including Fluvoxamine) are more useful. There can be several options to choose from including either increasing the dose of Fluvoxamine or adding another antidepressant or changing the medicine altogether.

For managing anxiety symptoms or symptoms related to insecurity, alongside medication, relaxation techniques and psychotherapy could also be useful. I would suggest a detailed psychiatric evaluation and review into the treatment history including duration of use of the particular medication, the dosage, the regularity with which it has been used. I also suggest a blood thyroid evaluation.