Dr. Phil Kronk: What you should know about obsessive thoughts and compulsive behaviors

“Everybody is dealing with how much of their own aliveness they can bear and how much they need to anesthetize themselves.” Adan Phillips, Ph.D.

 “To grow up is to discover what one is unequal to.” Adam Phillips, Ph.D.

You are not alone if you suffer from an anxiety. At times, the world can feel overwhelming.

While we tend to see television commercials for depression or for bipolar disorder, the reality is that anxiety disorders are the most common form of mental suffering in our country.

One of five adults report some form of anxiety each year, but only slightly more than one third of these individuals receive treatment and relief from their suffering.

This month, in this column, I would like to focus on obsessive-compulsive forms of thinking and behaving.

For decades, mental health professionals viewed obsessive-compulsive disorder (OCD) as purely one type of anxiety disorder. While anxiety is certainly an important experienced component of OCD, today it is diagnosed as an “impulsive-compulsive disorder.”

Today, many clinicians and researchers realize that OCD is related to impaired neural brain circuits. I will share where mental health professionals believe these impaired neural brain circuits are located in one of the next columns.

Obsessions are intrusive and unwanted thoughts, urges or images that cause distress or anxiety.

Compulsions are repetitive behaviors or mental actions (such as counting, etc.) that a person performs in a rigid way in an attempt to respond to and alleviate an obsession.

Such anxiety can affect anyone. The singer-songwriter, Fiona Apple, shares that she “had a really bad obsessive-compulsive disorder.” She remembered that “At its worst, I was compelled to leave my house at three o’clock in the morning and go out in the alley because I just knew that the paper-towel roll I threw in the recycling bin was uncomfortable, like it was lying the wrong way, and it should be down in the garbage.”

Anxiety is rarely experienced by itself for many individuals. Depression often accompanies an anxiety disorder in half of those diagnosed with an anxiety disorder.

While the average age for an obsessive-compulsive disorder’s onset is around nineteen years of age, children also experience such symptoms.

In the next four weeks, in this column on mental health, I would like to share the extent of the destructiveness of the tendency to ruminate for individuals with obsessive-compulsive behaviors. I will also share some techniques to quiet the ruminations.

The need for perfection will be addressed, and the strain it can place on an individual. Guilt and shame are often intertwined with an over-concern about what others are thinking of us.

The obsessive-compulsive’s need to control will be addressed. So, will the need to be “sure.” And, the need, by some, to known what exactly reality is.

The difference between anxiety and fear will be addressed, as will be the fact that anxiety has both a biological and a cognitive etiology.

This is important because effective treatment for obsessive thoughts/urges and compulsive actions needs to have a dual form of combined treatment. Both cognitive therapy and medication can be effective in bringing relief and ending suffering.

Phil Kronk, M.S., Ph.D. is a semi-retired child and adult clinical psychologist and clinical neuropsychologist. Dr. Kronk has a doctorate in clinical psychology and a postdoctoral degree in clinical psychopharmacology (the use of drugs to treat mental disorders.) His year-long internship in clinical psychology was served at the University of Colorado Medical School. Dr. Kronk writes a weekly, Friday online column on mental health for the Knoxville News Sentinel’s website, knoxnews.com. He can be reached at (865) 330-3633.

 

Dr. Phil Kronk: What you should know about obsessive thoughts and …

“Everybody is dealing with how much of their own aliveness they can bear and how much they need to anesthetize themselves.” Adan Phillips, Ph.D.

 “To grow up is to discover what one is unequal to.” Adam Phillips, Ph.D.

You are not alone if you suffer from an anxiety. At times, the world can feel overwhelming.

While we tend to see television commercials for depression or for bipolar disorder, the reality is that anxiety disorders are the most common form of mental suffering in our country.

One of five adults report some form of anxiety each year, but only slightly more than one third of these individuals receive treatment and relief from their suffering.

This month, in this column, I would like to focus on obsessive-compulsive forms of thinking and behaving.

For decades, mental health professionals viewed obsessive-compulsive disorder (OCD) as purely one type of anxiety disorder. While anxiety is certainly an important experienced component of OCD, today it is diagnosed as an “impulsive-compulsive disorder.”

Today, many clinicians and researchers realize that OCD is related to impaired neural brain circuits. I will share where mental health professionals believe these impaired neural brain circuits are located in one of the next columns.

Obsessions are intrusive and unwanted thoughts, urges or images that cause distress or anxiety.

Compulsions are repetitive behaviors or mental actions (such as counting, etc.) that a person performs in a rigid way in an attempt to respond to and alleviate an obsession.

Such anxiety can affect anyone. The singer-songwriter, Fiona Apple, shares that she “had a really bad obsessive-compulsive disorder.” She remembered that “At its worst, I was compelled to leave my house at three o’clock in the morning and go out in the alley because I just knew that the paper-towel roll I threw in the recycling bin was uncomfortable, like it was lying the wrong way, and it should be down in the garbage.”

Anxiety is rarely experienced by itself for many individuals. Depression often accompanies an anxiety disorder in half of those diagnosed with an anxiety disorder.

While the average age for an obsessive-compulsive disorder’s onset is around nineteen years of age, children also experience such symptoms.

In the next four weeks, in this column on mental health, I would like to share the extent of the destructiveness of the tendency to ruminate for individuals with obsessive-compulsive behaviors. I will also share some techniques to quiet the ruminations.

The need for perfection will be addressed, and the strain it can place on an individual. Guilt and shame are often intertwined with an over-concern about what others are thinking of us.

The obsessive-compulsive’s need to control will be addressed. So, will the need to be “sure.” And, the need, by some, to known what exactly reality is.

The difference between anxiety and fear will be addressed, as will be the fact that anxiety has both a biological and a cognitive etiology.

This is important because effective treatment for obsessive thoughts/urges and compulsive actions needs to have a dual form of combined treatment. Both cognitive therapy and medication can be effective in bringing relief and ending suffering.

Phil Kronk, M.S., Ph.D. is a semi-retired child and adult clinical psychologist and clinical neuropsychologist. Dr. Kronk has a doctorate in clinical psychology and a postdoctoral degree in clinical psychopharmacology (the use of drugs to treat mental disorders.) His year-long internship in clinical psychology was served at the University of Colorado Medical School. Dr. Kronk writes a weekly, Friday online column on mental health for the Knoxville News Sentinel’s website, knoxnews.com. He can be reached at (865) 330-3633.

 

Comorbid Considerations Q&A: Treating Bipolar Disorder, Depression, Anxiety, or Autism Alongside ADHD

Comorbidity is the rule, not the exception, in most psychiatric practices. Clinicians today must possess a thorough and nuanced understanding of disparate conditions in order to effectively diagnose and treat their patients’ symptoms attention deficit disorder (ADHD or ADD).

This is the overarching principle of Dr. Anthony Rostain, professor of psychiatry and pediatrics at the Perelman School of Medicine at the University of Pennsylvania and attending and supervising psychiatrist at the Children’s Hospital of Pennsylvania and the University of Pennsylvania Health System. Dr. Rostain — who is triple boarded in pediatrics, adult psychiatry, and child and adolescent psychiatry — was interviewed recently for an Ask the Experts webinar hosted by The American Professional Society of ADHD and Related Disorders (APSARD). This is the first of five articles based on his responses to questions from Dr. Gregory Mattingly of Washington University School of Medicine about aspects of treating ADHD. This article is presented for general educational purposes, not medical advice.

Dr. Mattingly: Mood disorders, bipolar disorder, and emotional dysregulation all occur with great regularity alongside symptoms of ADHD. As a clinician, how do you balance treating your patients for ADHD and for these and other comorbid conditions?

Dr. Rostain: The majority of patients seeking psychiatric treatment arrive with not just attention deficit disorder, but also a variety of mood disorders, anxiety disorders, substance use disorders, and the like. As clinicians, we must expect that adults with ADHD — particularly those who have not ever been treated or those who have been treated for ADHD but continue to experience impairing symptoms of the disorder — will come to us with complex presentations.

For this reason, my rule of thumb is this: Complete a comprehensive history regarding every aspect of the person’s past and present functioning, as well as a thorough history of past treatments for psychiatric disorders. That is the sine qua non of good care.

[Free Download: 9 Conditions Often Linked to ADHD]

The four most common conditions diagnosed alongside ADHD are bipolar disorder, depression, anxiety, and autism spectrum disorder.

1. ADHD and Bipolar Disorder

Data from the National Comorbidity Study suggests that, among people with ADHD, almost 20% report having some form of bipolar spectrum disorder. These patients not only have inattention, impulsivity, and hyperactivity, but also the severe mood swings and/or prolonged downturns associated with bipolar disorder.

In treating patients with comorbid ADHD and bipolar disorder, clinicians have historically been concerned about the possibility that stimulant treatment might induce or exacerbate bipolar mania. Thus, a mood stabilizer, if not already part of the treatment plan, should be introduced to minimize the chances of triggering mania.

The bigger challenge, as we have come to understand bipolar disorder better, has to do with the persistent depressive states that affect patients with both bipolar disorder and ADHD. Because stimulants don’t significantly improve the mood of patients with bipolar depression, I suggest treating bipolar depression first and saying to your patient, “Once your mood is more stable and/or you’re no longer as depressed then we can address your cognitive difficulties, your inattention, your problems with sustaining effort.”

[Self-Test: Bipolar Disorder in Adults]

I am asked frequently: What is your point of view on treating patients for bipolar disorder who are already successfully using stimulant medications? Does it make sense to keep patients on ADHD medications while initiating treatment for bipolar disorder? For example, a recent trial found that children with both ADHD and bipolar who were treated for both ADHD and bipolar had the best outcomes of any patients treated for bipolar disorder.

This is important. There is no reason to stop a medication that’s been helpful when you’re trying to treat a second condition. The bipolar patients I worry about using stimulants are college-aged students and/or people who are not getting enough sleep. With that rare exception, there is no reason not to use a stimulant while you’re treating the aspect of bipolar disorder that remains a problem.

2. ADHD and Depression

Both depression or dysthymia — either longstanding low-level depression or more severe depression — present frequently in patients with ADHD. The notion now is to introduce a medication such as bupropion (Wellbutrin) initially. Once the patient shows improvement in their mood, the clinician can decide how to add a stimulant to address ADHD symptoms.

There’s no simple algorithm for adding stimulants to medications for depression. The evidence suggests that stimulants can be effective in conjunction with these medications, but it is important to watch for side effects such as cardiovascular problems, weight loss or insomnia. As long as these basic functions are monitored carefully, you can proceed safely with stimulants.

[Self-Test: Depression in Adults]

It turns out that clinicians in the depression unit here at the University of Pennsylvania are more and more inclined to add stimulants to boost effective antidepressants. It is a fascinating time to be in psychiatry as we learn that the persistent cognitive impairments and/or inattentiveness or distractibility that many patients experience with depression can be helped by prescribing stimulants as an adjuvant for treatment-resistant depression.

3. ADHD and Anxiety

I am frequently asked by residents in my clinic how to disentangle anxiety from ADHD. Truth be told, it’s very difficult to do.

Anxiety can interfere greatly with both performance and focus. Thus the first step is to probe the patient’s history to understand how anxiety presents itself. In patients with both anxiety and ADHD, the two conditions feed one another. If the patient’s anxiety is largely performance anxiety — centering on difficulties with task performance or, in the case of a prior history of ADHD, on school, interpersonal or occupational difficulties caused by the patient’s ADHD-driven lack or reliability — then my advice is to treat the ADHD first.

If, on the hand, the patient presents with obsessive-compulsive disorder (OCD), longer-standing generalized anxiety disorder, or panic disorder, then I start a treatment plan directed at the anxiety itself. Some clinicians use Atomoxetine because it addresses both ADHD and comorbid anxiety. I have also come to appreciate the use of alpha agonists for people with anxiety and ADHD, especially those who have had a bad response to stimulants.

[Self-Test: Symptoms of Generalized Anxiety Disorder]

4. ADHD and Autism

Until the DSM-5, we were not supposed to diagnose autism and ADHD simultaneously, an error that has now been corrected. For patients with both conditions, ADHD stimulant medications have an effect size slightly lower than would be observed for patients without autism, but the data is clear that treatment for ADHD is warranted. The effect size in autism patients might be 0.5 instead of 0.7 or 0.7 instead of 0.9 for different stimulant classes. Nevertheless, there is absolutely no reason not to use doses that are comparable to any other patient to start with.

As long as your patient is not having side effects, start the dosage low and increase it slowly — continuing until the patient has a clinical response. As a rule, I try both methylphenidate and amphetamine so I can judge which is more effective. In cases of patients with sensory difficulties, I sometimes use the new liquid and oral disintegrating tablet (ODT) formulations of ADHD stimulant medications.

Medication efficacy is challenging to assess when your patient cannot report well or is not able to observe the effects of medications. You need good collateral information, such as the usual teacher or parent data, and you also need to observe the patient’s performance on tasks presented in the office.


CW: The Anxiety of Alma Fischer: A Webcomic About Anxiety, Depression & Obsessive-Compulsive Disorder

Many years ago, I took a theatrical script analysis class at Marymount Manhattan College. Back then, I was an awful student. I didn’t go to class more than I did go, and I loved a good party. At a rare occasion when I went to class, my professor talked about a one-act play that stayed with me.

I don’t remember the name of the play. I’m not sure I remember the plot particularly well. Still, the amorphous anti-plot, the loneliness, and the absurd realism of it all stuck with me decades later.

As someone who deals with anxiety, depression, and obsessive-compulsive disorder — just to name a few things — I’m well aware of the power of comics and graphic novels, particularly in memoir or non-fiction form. Comics felt like the perfect medium to express the crushing experience of living with intrusive thoughts and the debilitating weight of hopelessness depression causes.

I’m honored to have worked with artist Mair Sierra and editor Kat Vendetti on this webcomic.

Please heed our content warning moving forward!


The Anxiety of Alma Fischer by Justin Alba cover
The Anxiety of Alma Fischer by Justin Alba page 1 The Anxiety of Alma Fischer by Justin Alba page 2 The Anxiety of Alma Fischer by Justin Alba page 3 The Anxiety of Alma Fischer by Justin Alba page 4 The Anxiety of Alma Fischer by Justin Alba page 5 The Anxiety of Alma Fischer by Justin Alba page 6

WCTC will host a movie screening and an expert panel discussion about obsessive-compulsive disorder

With Obsessive-Compulsive Disorder Week happening the second week of October, OCD Wisconsin, based in Oconomowoc, wants to educate people on the disorder that affects 1 in 100 adults and 1 in 200 children and teens.

Beginning at 6:30 p.m. Thursday, Oct. 11, “Unstuck: An OCD Kids Movie” will be screened at Waukesha County Technical College’s Richard T. Anderson Center in Pewaukee.

Additionally, a panel of experts will discuss OCD and open the floor for questions and answers. The event will conclude at 8 p.m.

OCD is a common, chronic and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that he or she feels the urge to repeat over and over, according to the National Institute of Mental Health website.

Dr. Bradley Riemann, who serves as chief clinical officer for Rogers Behavioral Health, will be one of the speakers at the event.


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“Dr. Riemann is a leading expert in the assessment of obsessive-compulsive disorder and anxiety disorders and use of cognitive behavioral therapy treatment,” a news release stated. “At Rogers, he serves as the clinical director of the adult OCD Center, one of the leading residential treatment centers for OCD and anxiety in the country. He also directs cognitive behavioral therapy services at Rogers.”

Riemann has also authored numerous scientific papers on obsessive-compulsive disorder and anxiety and has spoken at national and international conventions, according to the release.

Chad Wetterneck, a licensed clinical psychologist who specializes in using cognitive behavioral therapy in the treatment of anxiety and post-traumatic stress disorder, will also speak.

“Dr. Wetterneck has developed training modules and interventions for application in Rogers’ residential, partial hospitalization, and intensive outpatient programs,” the release stated. “He supervises the behavioral specialists treating residential adult patients with dual diagnoses in the Herrington Recovery Center, and developed and oversees the PTSD partial hospital programs at Rogers’ West Allis, Brown Deer, Oconomowoc, and Appleton locations.”

Psychologist Nicholas Farrell will also speak at the event. Farrell provides clinical consultation and supervises the work of the behavioral specialists in Rogers’ Eating Disorder Center as well as in the inpatient, partial hospitalization and intensive outpatient programs.

“Dr. Farrell embraces an integrated care model that promotes collaboration between patients and the health professionals involved in their care,” the release stated.

The event is free and open to the public, but registration is required. To register, email Kia LaBracke at ocdwisconsin@gmail.com.

OCD Wisconsin was founded in 2013 as the Wisconsin affiliate of the International OCD Foundation with the mission to be a trusted resource and voice for those affected by OCD.

Top Headlines Around the Community:

Here’s a roundup of many fall activities and events in the Milwaukee suburbs

Oak Creek man who was shot by police found dead

Photos: Check out these gorgeous images of Pewaukee Lake

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Paroxetine: Side effects, dosage, uses, and more

Highlights for paroxetine

  1. Paroxetine oral tablet is available in immediate-release and extended-release forms. It’s also available as both a generic drug and brand-name drugs. Brand names: Paxil, Paxil CR, and Pexeva.
  2. Paroxetine is also available as an oral capsule and oral suspension.
  3. Paroxetine oral tablet can be used to treat depressive disorder, obsessive-compulsive disorder, panic disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder, and premenstrual dysphoric disorder.


Important warnings

FDA warning: Suicide warning

  • This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
  • Antidepressant medications such as paroxetine may increase suicidal thoughts and behaviors, especially within the first few months of treatment or when your dose is changed. This risk is higher in children, teenagers, and young adults. You, family members, caregivers, and your doctor should pay attention to any unusual changes in your mood, behaviors, thoughts, or feelings.

Other warnings

  • Serotonin syndrome warning: This drug can cause a potentially life-threatening condition called serotonin syndrome. It can be caused by this drug alone or with the use of other medications that have similar effects. Symptoms of serotonin syndrome can include agitation, hallucinations, confusion, trouble thinking, coma, coordination problems, and muscle twitching (overactive reflexes).
  • Worsened depression warning: Paroxetine may worsen your depression. If you experience any unusual changes in behavior, especially during the first few months of treatment or when your dose changes, call your doctor. These can include anxiety, restlessness, panic attacks, sleeplessness, irritability, aggressiveness, acting on dangerous impulses, attempts to commit suicide, and extreme mood swings.
  • Stopping treatment warning: If you’re stopping treatment with this drug, it should be done gradually and with your doctor’s guidance. Don’t stop taking this drug abruptly. Withdrawal symptoms can occur when this drug is stopped too quickly. Symptoms of withdrawal include anxiety, irritability, restlessness, changes in sleep habits, headache, sweating, nausea, dizziness, shaking, and confusion. You should be monitored for these symptoms when stopping treatment with paroxetine.

What is paroxetine?

Paroxetine oral tablet is a prescription drug. It’s available in immediate-release and extended-release forms. These forms are available as the brand-name drugs Paxil, Paxil CR, and Pexeva. All brands do not treat all conditions.

Paroxetine oral tablet is also available as a generic drug. Generic drugs usually cost less than brand-name versions. In some cases, they may not be available in all strengths or forms as brand-name drugs.

Paroxetine also comes as an oral capsule and an oral solution.

Why it’s used

Paroxetine can be used to treat the following conditions:

Paroxetine may be used as part of a combination therapy. This means you may need to take it with other medications.

How it works

Paroxetine belongs to a class of drugs called selective serotonin reuptake inhibitors. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Paroxetine increases the amount of the hormone serotonin that your body makes and releases in your brain. Serotonin helps with symptoms of depression, compulsions, stress, and anxiety.


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Paroxetine side effects

Paroxetine oral tablet can cause drowsiness and may affect your ability to make decisions, think clearly, or react quickly. You shouldn’t drive, use heavy machinery, or do other activities for which you need to be alert until you know how this drug affects you.

Paroxetine can also cause other side effects.

More common side effects

The more common side effects of paroxetine oral tablet can include:

  • nausea
  • sleepiness
  • weakness
  • dizziness
  • anxiousness or sleeplessness
  • delayed ejaculation
  • decreased sexual desire
  • impotence
  • sweating
  • shaking
  • decreased appetite
  • dry mouth
  • constipation
  • infection
  • yawning

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Changes in mood, anxiety or behavior, such as:
    • new or worsened depression
    • new or worsened anxiety or panic attacks
    • thoughts of suicide or dying
    • attempts to commit suicide
    • acting on dangerous impulses
    • acting aggressive or violent
    • agitation, restlessness, anger, or irritability
    • sleeplessness
    • increase in activity or talking more than what is normal for you
  • Serotonin syndrome or neuroleptic malignant syndrome-like reactions. Symptoms can include:
    • agitation, hallucinations, coma, confusion, and trouble thinking
    • coordination problems or muscle twitching (overactive reflexes)
    • muscle rigidity
    • racing heartbeat
    • high or low blood pressure
    • sweating
    • fever
    • nausea, vomiting, or diarrhea
  • Eye problems, such as:
    • eye pain
    • changes in vision
    • swelling or redness in or around your eyes
  • Severe allergic reactions. Symptoms can include:
    • trouble breathing
    • swelling of your face, tongue, eyes, or mouth
    • rash
    • hives (itchy welts)
    • blisters
    • fever
    • joint pain
  • Abnormal bleeding
  • Seizures or convulsions
  • Manic episodes. Symptoms can include:
    • greatly increased energy
    • severe trouble sleeping
    • racing thoughts
    • reckless behavior
    • unusually grand ideas
    • excessive happiness or irritability
    • talking more or faster than usual
  • Changes in appetite or weight
  • Low sodium levels. Symptoms can include:
    • headache
    • weakness or feeling unsteady
    • confusion, problems concentrating or thinking, or memory problems
  • Bone fracture. Symptoms can include:
    • unexplained bone pain
    • tenderness
    • swelling
    • bruising

Paroxetine and suicide

SSRIs, such as paroxetine, may cause or increase suicidal thoughts and behaviors. The risk is especially high during the first few months of treatment, or following a change in dosage. Children, teenagers, and young adults are at highest risk for these symptoms. Contact your doctor right away if you experience any unusual or sudden changes in behaviors, thoughts, or mood when taking this drug. Learn more about antidepressants and suicide risk here.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Paroxetine may interact with other medications

Paroxetine oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with paroxetine are listed below.

Drugs you should not take with paroxetine

Do not take these drugs with paroxetine. Taking these drugs with paroxetine can cause dangerous effects in your body. Examples of these drugs include:

  • Thioridazine. Taking this drug with paroxetine can cause serious heart rhythm problems or sudden death.
  • Pimozide. Taking this drug with paroxetine can cause serious heart problems.
  • Monoamine oxidase (MAO) inhibitors, such as isocarboxazid, phenelzine, and tranylcypromine. Taking these drugs with paroxetine increases your risk of serotonin syndrome so much that they should not be taken with paroxetine. You should wait at least 14 days between use of paroxetine and these drugs.
  • Tryptophan (found in dietary supplements). Taking tryptophan with paroxetine increases your risk of serotonin syndrome. It should not be taken with paroxetine.
  • Linezolid, and intravenous methylene blue. Taking these drugs with paroxetine increases your risk of serotonin syndrome so much that they should not be used together.

Interactions that can increase your risk of side effects

Taking paroxetine with certain drugs raises your risk of side effects. Examples of these drugs include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as, ibuprofen and naproxen as well as aspirin and warfarin. Taking these drugs with paroxetine can increase your risk of bleeding or bruising.
  • Triptans such as sumatriptan
  • Lithium
  • Serotonergic drugs, such as fentanyl, tramadol, and St. John’s wort. Taking these drugs with paroxetine can increase your risk of serotonin syndrome.
  • Amphetamines, such as lisdexamfetamine and methamphetamine. Taking these drugs with paroxetine can increase your risk of serotonin syndrome.
  • Theophylline. Taking this drug with paroxetine can increase your risk of restlessness, trouble sleeping, and irritability.
  • Risperidone. Taking this drug with paroxetine can increase your risk of sleeping difficulty, anxiety, restlessness, and constipation.
  • Cimetidine
  • Antiarrhythmics, such as flecainide, and propafenone
  • Phenothiazines, such as chlorpromazine, and fluphenazine
  • Tricyclic antidepressants (TCAs), such as amitriptyline, imipramine and desipramine
  • Quinidine. Taking this drug with paroxetine can increase your risk of tiredness, decreased appetite, sweating, dry mouth, and decreased sexual desire.

Interactions that can make drugs less effective

Taking paroxetine with certain drugs may cause one or both of the drugs to not work as well. This is because the interaction between the drugs may cause a decrease in your body of paroxetine or the other drug. Examples of these drugs include:

  • Tamoxifen, a breast cancer drug
  • Digoxin
  • Protease inhibitors, such as fosamprenavir and ritonavir
  • Phenobarbital
  • Phenytoin

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.


Paroxetine warnings

Paroxetine oral tablet comes with several warnings.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms can include:

  • trouble breathing
  • swelling of your face, tongue, eyes, or mouth
  • rash, itchy welts (hives), or blisters, alone or with fever or joint pain

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction

You should avoid drinks that contain alcohol when taking this drug.

Warnings for people with certain health conditions

For people with glaucoma: Paroxetine may dilate your pupils, which may trigger a glaucoma attack. Notify your doctor if you have glaucoma before taking this drug.

For people with bipolar disorder: Caution should be used when taking this drug if you have bipolar disorder. Taking paroxetine alone may trigger a mixed or manic episode.

For people with seizures: Caution should be used when taking this drug if you have a history of seizures. If seizures occur while you take this drug, you should stop taking it and contact your doctor.

For people with kidney disease: If you have kidney disease, your kidneys may not be able to get rid of this drug as well as they should. This may cause levels of the drug to build up in your body and cause more side effects.

For people with liver disease: If you have liver disease, your body may not be able to process this drug as well as it should. This may increase the levels of this drug to build up in your body and cause more side effects.

Warnings for other groups

For pregnant women: Paroxetine oral tablet is a category D pregnancy drug. That means two things:

  1. Research in humans has shown adverse effects to the fetus when the mother takes the drug.
  2. This drug should only be used during pregnancy in serious cases where it’s needed to treat a dangerous condition in the mother.

Talk to your doctor if you’re pregnant or planning to become pregnant. Ask your doctor to tell you about the specific harm that may be done to the fetus. This drug should be only used if the potential risk is acceptable given the drug’s potential benefit. Call your doctor right away if you become pregnant while taking this drug.

For women who are breastfeeding: This drug passes into breast milk and may cause side effects in a child who is breastfed. Caution should be used when taking this drug while breastfeeding. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors: The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

If you’re over the age of 65, you may be at higher risk of developing side effects while taking this drug, including low sodium levels in your blood (hyponatremia).

For children: It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

How to take paroxetine

This dosage information is for paroxetine oral tablet. All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

Forms and strengths

Generic: Paroxetine

  • Form: Immediate-release oral tablet
  • Strengths: 10 mg, 20 mg, 30 mg, 40 mg
  • Form: Extended-release oral tablet
  • Strengths: 12.5 mg, 25 mg, 37.5 mg

Brand: Paxil

  • Form: Immediate-release oral tablet
  • Strengths: 10 mg, 20 mg, 30 mg, 40 mg

Brand: Paxil CR

  • Form: Extended-release oral tablet
  • Strengths: 12.5 mg, 25 mg, 37.5 mg

Brand: Pexeva

  • Form: Immediate-release oral tablet
  • Strengths: 10 mg, 20 mg, 30 mg, 40 mg

Dosage for major depressive disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The typical starting dose is 20 mg per day.
    • If a 20-mg dose is not enough, your doctor will start increasing your dose each week by 10 mg per day.
    • Your maximum daily dose shouldn’t exceed 50 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The initial dose is 25 mg per day.
    • If you don’t respond to a 25-mg dose, your doctor will increase your dose each week by 12.5 mg per day.
    • The maximum dose is 62.5 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

Special dosage considerations

For severe kidney disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

For severe liver disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dosage is 12.5 mg per day.
    • The maximum dosage is 50 mg per day.

Dosage for obsessive-compulsive disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The typical starting dose is 20 mg per day.
    • The target dose is 40 mg day. Your doctor will increase your dose each week by 10 mg per day to get to the target dose.
    • The maximum dose is 60 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

Special dosage considerations

For severe kidney disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

For severe liver disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

Dosage for panic disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The typical starting dose is 10 mg per day.
    • The target dose is 40 mg per day. Your doctor will increase your dose each week by 10 mg per day to get to the target dose.
    • The maximum dose is 60 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The initial dose is 12.5 mg per day.
    • If you don’t respond to a 12.5-mg dose, your doctor will increase your dose each week by 12.5 mg per day.
    • The maximum dose is 75 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg once per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

Special dosage considerations

For severe kidney disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

For severe liver disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dosage is 12.5 mg per day.
    • The maximum dosage is 50 mg per day.

Dosage for social anxiety disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Immediate-release oral tablets (Paxil):
    • The typical starting dose is 20 mg per day.
    • If a 20 mg dose is not enough, your doctor will start increasing your dose each week by 10 mg per day.
    • The recommended dose to treat social anxiety disorder is 20–60 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The initial dose is 12.5 mg per day.
    • If you don’t respond to a 12.5-mg dose, your doctor will increase your dose each week by 12.5 mg per day.
    • The maximum dose is 37.5 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Immediate-release oral tablets (Paxil):
    • The recommended starting dose is 10 mg once per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

Special dosage considerations

For severe kidney disease

  • Immediate-release oral tablets (Paxil):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

For severe liver disease

  • Immediate-release oral tablets (Paxil):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.
  • Extended-release oral tablets (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.

Dosage for generalized anxiety disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The typical starting dose is 20 mg per day.
    • If a 20-mg dose is not enough, your doctor will start increasing your dose each week by 10 mg per day.
    • The recommended dose to treat generalized anxiety disorder is 20–50 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg once per day.
    • The maximum dose is 40 mg per day.

Special dosage considerations

For severe kidney disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

For severe liver disease

  • Immediate-release oral tablets (Paxil, Pexeva):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

Dosage for post-traumatic stress disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Immediate-release oral tablets (Paxil):
    • The typical starting dose is 20 mg per day.
    • If a 20-mg dose is not enough, your doctor will start increasing your dose each week by 10 mg per day.
    • The recommended dose to treat post-traumatic stress disorder is 20–50 mg per day.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Immediate-release oral tablets (Paxil):
    • The recommended starting dose is 10 mg once per day.
    • The maximum dose is 40 mg per day.

Special dosage considerations

For severe kidney disease

  • Immediate-release oral tablets (Paxil):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

For severe liver disease

  • Immediate-release oraltablets (Paxil):
    • The recommended starting dose is 10 mg per day.
    • The maximum dose is 40 mg per day.

Dosage for premenstrual dysphoric disorder

Adult dosage (ages 18–64 years)

You should take this drug in one dose per day. You should be on the lowest dose that works for you.

  • Extended-release oral (Paxil CR):
    • The typical starting dose is 12.5 mg per day, usually taken in the morning.
    • Depending on your symptoms, your dose can be increased up to 25 mg per day.
    • Dose changes should occur at intervals of at least one week.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that this drug is safe and effective for use in people younger than 18 years.

Senior dosage (ages 65 years and older)

  • Extended-release oral (Paxil CR):
    • The recommended starting dose is 12.5 mg once per day
    • The maximum dose is 50 mg per day.

Special dosage considerations

For severe kidney disease

  • Extended-release oral (Paxil CR):
    • The recommended starting dose is 12.5 mg per day.
    • The maximum dose is 50 mg per day.

For severe liver disease

  • Extended-release oral (Paxil CR):
    • The recommended starting dosage is 12.5 mg per day.
    • The maximum dosage is 50 mg per day.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.


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Take as directed

Paroxetine oral tablet can be used for long-term or short-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: If you don’t take it at all, your condition won’t get any better. If you suddenly stop taking it, you may see symptoms, such as anxiety, irritability, high or low mood, restlessness, changes in sleep habits, headache, sweating, nausea, dizziness, electric shock-like sensations, shaking, and confusion.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

  • sleepiness
  • dizziness
  • nausea
  • vomiting
  • fast heart rate
  • tremor
  • confusion
  • coma

If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working:

  • Major depressive disorder. You should have decreased feelings of depression and your mood should improve.
  • Obsessive-compulsive disorder. You should have decreased feelings of obsessions and compulsions.
  • Panic disorder. You should have decreased feelings of anxiety and panic.
  • Social anxiety disorder. You should have decreased feelings of anxiety.
  • Generalized anxiety disorder. You should have decreased feelings of anxiety.
  • Post-traumatic stress disorder. You should have decreased feelings of anxiety, memories, or dreams of traumatic events (flashbacks) and nightmares.
  • Premenstrual dysphoric disorder. You should have decreased tiredness, irritability, mood swings, sleeplessness, and anxiety.

Important considerations for taking paroxetine

Keep these considerations in mind if your doctor prescribes paroxetine oral tablets for you.

General

  • You can take this drug with or without food.
  • Take the oral tablet in the morning.
  • You can cut or crush the immediate-release oral tablet
  • You can’t chew, crush, or cut the extended-release tablet. It must be swallowed whole.
  • Not every pharmacy stocks all forms or brands of this drug. When filling your prescription, be sure to call ahead.

Storage

  • Store the oral tablets at room temperature between 59°F and 86°F (15°C and 30°C). Store the extended-release tablets at or below 77°F (25°C).
  • Keep this drug away from light.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

  • Mental health and behavior changes
  • Kidney function. Your doctor may have blood tests done to check how well your kidneys are working. If your kidneys aren’t working well, your doctor may decide to lower your dose of this drug.
  • Liver function. Your doctor may have blood tests done to check how well your liver is working. If your liver isn’t working well, your doctor may decide to lower your dose of this drug.

Insurance

Many insurance companies require a prior authorization for certain forms or brands of this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Jury in Kingston murder case due to start deliberating Wednesday

KINGSTON, N.Y. — Jury deliberations are expected to begin Wednesday in the murder trial of Seth Lyons.

The prosecution and defense rested their cases Tuesday after psychiatric experts offered conflicting testimony about Lyons’ mental health history and his mental state at the time he killed 49-year-old homeless man Anthony Garro.

Garro’s badly beaten body was found around 9 a.m. Nov. 29, 2017, beneath the Elmendorf Street overpass along the unused Ulster County-owned railroad corridor that runs through Midtown Kingston. Lyons, 20, of Ulster Park, has confessed to the attack, but the defense contends he didn’t mean to kill Garro and that he suffered from “extreme emotional disturbance.”

Lyons was spotted at a local convenience store a few hours after the fatal attack, still wearing the bloodstained clothes he had on at the time he beat Garro with his fists, a beer bottle, rocks, a brick and a tree stump.

He admitted to police that he pummeled Garro — first because he believed Garro had stolen his cell phone, then because he thought Garro was trying to sexually assault him.

On Monday, Dr. Stephen Price testified under questioning by defense attorney Bryan Rounds that Lyons suffered from bipolar disorder, schizoaffective disorder, obsessive-compulsive disorder, depression, anxiety, paranoia and post-traumatic stress disorder, and that he had a long history of significant drug abuse. Price said Lyons’ actions were brought on by mental illness and drugs and were “triggered” by the belief that Garro was trying to sexually assault him.

The prosecution says Lyons intended to kill Garro because he believed Garro had stolen his cell phone and wouldn’t empty his pockets to prove he didn’t have the device.

Under questioning by Ulster County Chief Assistant District Attorney Michael Kavanagh, Price testified that Lyons was aware of what he was doing when he struck Garro repeatedly.

“And when he picked up that boulder and dropped it on him?” Kavanagh asked.

“It was all part of the beating,” Price said, adding that Lyons “intended to assault” Garro.

Dr. Kevin Smith, the psychiatrist called by the prosecution, rejected Price’s findings, saying that, in his opinion, “Seth Lyons did not lack the requisite capacity to form intent to commit the crime” and “did not suffer extreme emotional disturbance.”

Smith said Lyons suffered from an antisocial personality disorder with substance-induced bipolar disorder. The psychiatrist said he rejected the notion that Lyons suffered from “extreme emotional disturbance” at the time he killed Garro because he was able to recall details of the incident.

Under cross-examination, Rounds tried to elicit from Smith testimony that would show the prosecution witness was cherry-picking the psychiatric information he shared with jurors, reading off a laundry list of diagnoses from other medical professionals that Smith had not detailed for jurors, including that Lyons had been diagnosed as bipolar from a young age and that he had been hospitalized on at least five occasions since he was 14 specifically related to bipolar and anxiety disorders.

The two sides will deliver are to their closing statements to jurors when court resumes at 9:30 a.m. Wednesday.

Ulster County Judge Donald A. Williams said he will give jurors the option of convicting Lyons of second-degree murder, first-degree manslaughter or second-degree manslaughter. Additionally, if jurors find that the facts support all the elements necessary to find Lyons guilty of murder, he will allow jurors to decide whether the defense has proven to them that Lyons’ actions were the result of “extreme emotional disturbance.”

Obsessive Compulsive Disorders Evident in Duchenne Patients and in Need of Treatment, Study Says

Obsessive compulsive disorder (OCD), a type of “internalizing disorder,” are evident in children with Duchenne muscular dystrophy, and particularly associated with anxiety and places considerable stress on the patient’s family, a small retrospective study reported.

Researchers call attention to the importance of care providers being alert to signs of OCD and anxiety in patients, and treating their mental as well as physical health.

Their study “Descriptive Phenotype of Obsessive Compulsive Symptoms in Males With Duchenne Muscular Dystrophy” was published in the Journal of Child Neurology.

Previous work has shown a higher-than-average prevalence of behavioral or emotional disorders like OCD — known as internalizing disorders — in boys with Duchenne muscular dystrophy (DMD). But these studies do not detail the clinical symptoms that mark this patient population.

A team of researchers at University of Iowa sought to characterize the clinical signs, impact on patients and families, and response to treatment of internalizing disorders in DMD patients.

They retrospectively reviewed medical charts of boys and men, ages 5 to 34, being treated at the University of Iowa Hospital and Clinics between 2012 and 2017.

In total, data on 107 patients were reviewed; the study focused on a final group of 39 Duchenne patients. Of these, 15 exhibited OCD spectrum symptoms (14.0%), anxiety was evident in 27 patients (25.2%), and 14 had signs of depression (13.1%), the study reported. Often, symptoms of more than one disorder were reported in patients.

The mean age at OCD onset was 12.1 years, but the study reported evidence of symptoms having started earlier — as young as age 5 — although not problematic until the patients were older. At the time of the study, these 15 people ranged in age from 5 to 23.

Anxiety was also more likely to affect Duchenne boys with evidence of OCD (73.3%) than is common; anxiety at notable levels is usually seen in about 50% of other young patients with OCD.

Patients’ daily life and that of their families were often unsettled by these internalized disorders. Three cases were emphasized in the study, detailing patients who began experiencing OCD symptoms at very early ages, ranging from 4 to 6.

Irritability and distress in these children significantly disturbed family routines and quality of life. Symptoms also worsened as patients grew older, but treatment with selective serotonin reuptake inhibitors (SSRIs), a common type of antidepressant, resulted in consistent improvements over time. 

Records showed that psychotherapy was recommended to all 15 OCD patients in the study — whether evaluated by psychiatrists (nine patients) or doctors in their healthcare team — but only five were getting routine treatment by a psychiatrist or a therapist.

Most, 14 of the 15, were using SSRIs prescribed to them, a finding the researchers attributed to limited access to psychotherapy or financial burden.  According to the study, SRRIs given these patients included fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and clonazepam.

These medicines did not completely resolve OCD symptoms, but patients and families reported their use helpful in easing anxiety and greatly improving quality of life.

“Our data affirm that internalizing disorders are prevalent in the Duchenne muscular dystrophy population, warranting clinical attention and screening, as generally early diagnosis and treatment are associated with greater symptom improvement,” the researchers concluded.

OCD and Muscular Dystrophy

Obsessive-compulsive disorder (OCD) is largely characterized by obsessions and compulsions which can overtake a person’s life. While previously labeled as an anxiety disorder, it is now listed in the DSM 5 under the heading of obsessive-compulsive and related disorders.

While not technically an anxiety disorder, the majority of people with OCD deal with anxiety issues and might even be diagnosed with a specific anxiety disorder, such as Generalized Anxiety Disorder (GAD) or social anxiety disorder. Indeed, comorbid conditions with OCD are not unusual, and OCD can often be seen with depression and, to a lesser extent, with Bipolar Disorder and schizophrenia.

Now researchers have found that compared to the general population there is a higher than average prevalence of obsessive-compulsive disorder in those with Duchenne Muscular Dystrophy (DMD). DMD is a genetic illness that leads to progressive deterioration of muscle fibers. It usually only affects males but females can carry the mutated gene.

The study was published in May 2018 in the Journal of Child Neurology and was conducted by researchers from the University of Iowa. They worked on characterizing the clinical signs of OCD in those with DMD as well as its impact on patients and their families. The participants’ response to treatment was also studied.

The team reviewed the medical charts of 107 male patients aged 5-34 who had been treated at the University of Iowa Hospital and Clinics between 2012 and 2017. The study focused on a final group consisting of thirty-nine patients with DMD.  These patients, on the whole, exhibited higher levels than average of anxiety, depression and OCD, with symptoms of the disorders often overlapping. A total of fifteen subjects ranging in age from 5 – 23 exhibited signs of OCD. The mean age at onset was 12.1 years, but the study reported evidence of symptoms starting as early as age five.

The researchers said:

“Common initial symptoms included difficulty with changes in routine, repetitive behaviors, and organizational compulsions. Many patients required a very specific bedtime routine.”

“Our data affirm that internalizing disorders [OCD] are prevalent in the Duchenne muscular dystrophy population, warranting clinical attention and screening, as generally early diagnosis and treatment are associated with greater symptom improvement.”

Not surprisingly, the lives of families and patients with DMD are often negatively affected by the presence of obsessive-compulsive disorder. Distress and irritability in those suffering with both DMD and OCD significantly disturbed family routines and quality of life. Symptoms also tended to worsen as patients grew older, but treatment with selective serotonin reuptake inhibitors (SSRIs) resulted in consistent improvements over time. While medication did not completely resolve OCD symptoms, patients and their families reported they helped ease anxiety and improved their quality of life.

What I find particularly interesting about this study is that while psychotherapy (I’m hoping in the form of exposure and response prevention therapy) was recommended to all fifteen participants with OCD, only five were actually getting this treatment. In contrast fourteen of the fifteen subjects were taking SSRIs. The researchers attributed these statistics to a lack of access to qualified therapists as well as financial constraints felt by the families.

Once again, we see how difficult it can be for those with obsessive-compulsive disorder to get the proper treatment. Exposure and response prevention (ERP) therapy is the recommended, evidence-based psychological therapy for the treatment of OCD, but it is often out of reach for so many people. Those with DMD and OCD are likely to face unique challenges in terms of family accommodations and dynamics, and could benefit greatly from expert care and advice.

At the very least, this study brings OCD awareness to the forefront for those with DMD and their families. If OCD is recognized early and properly treated, its effect on lives can be minimal. And for those already living with the burden of DMD, that would surely be a good thing.

Fast Five Quiz: Generalized Anxiety Disorder

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Omega-3 Polyunsaturated Fatty Acids May Ease Anxiety

Treatment with omega-3 polyunsaturated fatty acids (PUFAs) may help reduce symptoms of anxiety, according to a new study published in JAMA Network Open.

The review and meta-analysis tapped data from 19 clinical trials which included 2240 participants (1203 treated with omega-3 PUFAs and 1037 without) from 11 countries. Participants had a wide range of psychiatric and physical conditions, including borderline personality disorder, depression, obsessive-compulsive disorder, Alzheimer’s disease, test anxiety, acute myocardial infarction, and premenstrual syndrome. Others were from the general population and had no specific clinical conditions.

“Although participants and diagnoses were heterogeneous, the main finding of this meta-analysis was that omega-3 PUFAs were associated with significant reduction in anxiety symptoms compared with controls,” researchers wrote. “This effect persisted vs placebo controls.”

The Role of Omega-3 Fatty Acids in Mental Health Care

Researchers also discovered daily dosages higher than 2000 mg were linked with a significantly higher anxiolytic effect, compared with lower dosages. In addition, supplements with less than 60% eicosapentaenoic acid (EPA) were significantly associated with reduced anxiety symptoms, but supplements with 60% or more EPA were not.

“The depression literature supports the clinical benefits of EPA-enriched formulations (≥60% or ≥50%) compared with placebo for the treatment of clinical depression,” researchers noted. “This opposite effect of EPA-enriched formations on anxiety and depression is intriguing and possibly linked to a distinct underlying mechanism of omega-3 PUFAs.”

Researchers voiced the need for larger, well-designed clinical trials to further investigate high-dose omega-3 PUFAs, both as monotherapy and as adjunctive treatment, in patients with anxiety.

—Jolynn Tumolo

Reference

Su K, Tseng P, Lin P, et al. Association of use of omega-3 polyunsaturated fatty acids with changes in severity of anxiety symptoms. JAMA Network Open. 2018 September 14.