Q: My son an engineering student, presently 20 years old was diagnosed with obsessive compulsive disorder (OCD) two years back. He is being treated with Flunil 40 and Fluvoxine 100 mg once a day. He takes a lot of time to bathe and wash his hands. His day-to-day work is suffering and he is lagging behind in his studies, shows general slowness in eating and taking decisions. He is finding it difficult to follow exposure and response prevention therapy (ERP) and CBD about, which the psychologist has told him. In fact he is reluctant to go for counselling but, , is consulting the psychiatrist and taking medicines regularly. He is of the opinion that he is trying to do his best. Sometimes, the condition of his hands becomes grim. The moment he tries to stop washing his hands he complains of stomachache, problem in the throat and uneasiness in general. Could you please throw some light on the magnitude of the trouble and side effects of the above medicines, if any? Can it be assessed how long the treatment will last or is it a chronic disease?

A:Flunil is the brand name; the name of the medicine is fluoxetine. Similarly Fluvoxin contains fluvoxamine. Both these drugs are used in the treatment of OCD. However both belong to the same class of drugs called SSRI, have similar mode of action and more or less similar side effects. Drugs belonging to the same class/group are not normally used concurrently for fear of potentiation of side effects while there is hardly any clinical benefit. For example both drugs can lead to suicidal tendency. In some cases, the concurrent use of these two such drugs can lead to the development of "serotonin syndrome" or "neuroleptic malignant syndrome" (NMS)-like events. These side effects are pretty serious. Therefore one should use only one drug belonging to SSRI class such as Flunil 40. If at all two drugs are required to control symptoms, then a drug belonging to another class should be added such as buspirone (Buscalm by Wockhardt), not the same class. Non-drug treatments such as CBD are always preferable, quite effective (as effective as drugs) and help to reduce both the dose and dependence on drugs. The symptoms of OCD are of waxing and waning nature. They can be reduced by gradual increase in exposure to stressful situations and assignments that substitute new activities for compulsive actions.