Q: I have OCD for the past 6 yrs and I am on venlafalxine 300 mg along with olanzapine, clonazapam. I just read on the internet that venlafalxine users may have side effects like racing thoughts, hyperactivity, increased persistent irritability etc. I am having all of these as I keep dreaming up gigantic plans which are unstoppable even while driving and irritability too has increased a lot after venlafaxine use. In the past I have tried clomipramine (left it after decreased effect), fluvoxitine (didn't work). My OCD and chronic depression have some relief with velafaxine but this day dreaming and increased irritability are bothering me a lot. I have weight loss and constipation with its use but these side effects don't bother me that much. Any advice on how to deal with these problems?

A:I do understand your distress due to the symptoms. It does seem that the diagnosis of OCD has been made correctly. The fact that you have tried Fluoxetine and Cloimipramine earlier and given up on them because of lack of desired effect or side effects is understandable, but it must be recognised that these drugs are the most effective ones for OCD and the dose does need to be titrated according to the side effects and taken to adequate levels. I suspect that has not happened and the drugs have been given up too early without adequate trial. I must say that Venlafaxine is not the most suitable drug for OCD, although I should like to respect the judgement of the treating clinician. There is one more drug, Fluvoxamine,which is quite effective in OCD. The option, for those persons who do not respond adequately to any of these drugs,is a combination of two of these drugs. All in all, there will have to be a systematic step wise approach to the drug management of OCD. The same can also be combined with Behaviour Therapy as and where suitable and possible. Most of the persons suffering from OCD can be helped significantly with the above approach to treatment,and there should be no reason to continue to suffer due to OCD except in the rarest of the rare cases. Please review the treatment with your treating clinician and don't lose hope because you can certainly be helped.