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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
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Experience:  GP in the United States
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Anxiety, OCD and impulse control? . I've had severe OCD

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Anxiety, OCD and impulse control?
Hi. I've had severe OCD for most of my life, as well as having a long term diagnosis of Asperger syndrome. My obsessive theme revolves around repugnant and constant unwanted sexual thoughts. These are highly disturbing and occur repeatedly. I had trichotillomania and intermittent fire setting as a child. I've had contamination ocd and harm ocd over the years.
Sometimes the images are so vivid that it feels like a real impulse to act. I don't have a bad bone in my body. I've been on 40mg of paroxetine for a year and it has elevated my mood slightly but I can't seem to stop compulsions. I also have depressive feelings due to the ocd and my asperger symptoms and I've rarely left the house for years.
Are there any herbal remedies or other methods of controlling these obsessive and persistent images/impulses.
Thanks.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 2 years ago.
Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.
Thanks for this question
what types of thoughts are you having?
Customer: replied 2 years ago.
The thoughts can contain people of the same gender, even though I'm heterosexual. I was told to watch gay pornography by a psychologist. I watched it for months and months and it bored me and never interested me. I'm extremely attracted to women and have zero attraction to men, yet I fear my sexual orientation will sudden,y change against my will.
Expert:  Dr. Phil, MD replied 2 years ago.
Okay.
So you are on medications and have done exposure therapy.
That is a good start
however, I find fluoxetine to be much more effective for OCD
I would suggest a change
Customer: replied 2 years ago.
Are there medications for impulse control, or do the ssris work for impulses. The impulses I experience come from vivid mental images and an urge to get rid of the huge anxiety that comes from them. What are the chances of ever acting on impulses I consider repugnant? I fear losing control and acting against my will.
Is paxil not good for ocd? Can I go straight from 40mg of paxil to prozac?
Expert:  Dr. Phil, MD replied 2 years ago.
Yes, the SSRIs do work for this
The dose might need to be changed too.
Yes, you can go from 40 mg of paxil to 40 mg of prozac
I would suggest a dose of 80 mg of prozac if needed
Customer: replied 2 years ago.
If I speak to my doctor, will he just put me on the prozac straight away? Will there be no effects from changing drugs or are all ssris of the same class? I've heard that paxil can be difficult to come off.
Expert:  Dr. Phil, MD replied 2 years ago.
SSRIs are all in the same class so you can switch over immediately. Yes, I hope he changes you straight away
they can all be tough to get off but you are not getting off you are just changing drugs
Customer: replied 2 years ago.
Why do you think fluoxetine is better? Have clinical trials demonstrated this? Here in the UK, doctors seem reluctant to prescribe paxil, and a psychiatrist only put me on it because some other family members are on it.
Why can paxil only go up to 60mg and fluoxetine go higher?
Expert:  Dr. Phil, MD replied 2 years ago.
I have simply had better luck with it with OCD. I am not aware of any trials that support this. However, there is really little evidence of an drugs working in OCD. Very tough to treat
Every drug has a different level of toxicity. Prozac happens to be 80 mg max.
Customer: replied 2 years ago.
I take promazine sometimes and it helps me sleep. Was it originally an anti psychotic?
Can I take inositol if I have 40mg of fluoxetine. There is a herbal remedy on amazon called zenphorol that has great reviews. Will it clash with the ssri?
Expert:  Dr. Phil, MD replied 2 years ago.
Yes, it was
I wouldn't use any of this herbal stuff with the SSRI
No one knows if it will interact or not. Better safe than sorry
Customer: replied 2 years ago.
Is sertraline good for OCD and depression, or should I just go with the prozac?
Expert:  Dr. Phil, MD replied 2 years ago.
sertraline is good too but my preference is prozac
Customer: replied 2 years ago.
Thanks for your advice. I will see my doctor soon.
Expert:  Dr. Phil, MD replied 2 years ago.
you're welcome
Please don't forget a positive rating. I appreciate it Craig. :)
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