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What are some good medicines for OCD with depression and insomnia?

Q: I am in my 20s (male) suffering from obsessive compulsive disorder (OCD) with chronic depression and insomnia for the past 6 yrs. Presently I am on Venlaflaxine 300 mg daily along with Nitrozapam 10mg for insomnia. I have slight relief with this but the symptoms of depression still exist with obsessiveness (repetition of thoughts and actions). I am feeling side effects like severe constipation, which exists even after being treated with Bisacodyl 10mg and Agrol daily. It also takes me a long time to ejaculate which I find very frustrating. Could you help me regarding these side effects and are there any non-habit forming medicines? Can you advise any other anti-depressants to help chronic depression and insomnia with OCD?

A:You have not mentioned whether you had tried some other medications earlier, and what were the responses. For OCD, we prefer Fluoxetine, Paroxetine and Fluvoxamine, and if symptoms persist, benzodiazepines, buspirone, or low dosage olanzepine can also be added as adjuvant medications. And for the side effects one has to consider the effectiveness of medications to the side effects and decide. Also, a detailed behavioural and cognitive program and therapy must be added as for OCD both medications and therapy need to go hand in hand for optimum improvement.

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