My First 3.5 Months on Prozac for OCD
One question I often receive is how Prozac has been working for my OCD. Since I have now been on Prozac for about 3.5 months, I thought it would be a good time to share my experience so far.
One thing that is important to understand is that OCD treatment with SSRIs is different from treating depression. People with OCD often require higher doses and longer treatment periods. Many OCD specialists recommend giving a therapeutic dose a fair trial for 8 to 16 weeks before deciding whether it is effective.
Although I have been taking Prozac for roughly 3.5 months, I have only been at my current dose of 80 mg for a few weeks. In many ways, I still feel like I am in the early stages of evaluating how well it works.
The First Week
My first week on 20 mg of Prozac felt incredible.
My brain had not yet adapted to the medication, and I experienced what many people describe as a "foggy" feeling. For me, that fogginess came with a dramatic reduction in compulsive urges. I would estimate my compulsions dropped by nearly 90% during that first week.
After struggling with severe OCD for years, it felt like a huge relief.
Unfortunately, the brain adapts. Over time, the compulsions gradually returned, and the improvement became less dramatic.
Adding Risperidone
As my symptoms returned, my psychiatrist decided to introduce Risperidone as an augmentation medication.
Typically, augmentation medications are added after a full therapeutic trial of the primary SSRI. In my case, my psychiatrist chose to add it earlier because I was still waking up at 3:00 AM and engaging in compulsive behaviors similar to what I was doing before treatment.
The results were noticeable.
I would estimate that Risperidone reduced my compulsive behaviors by about 35%. For someone with severe OCD, that is a meaningful improvement.
However, there were downsides.
My sexual function declined significantly. My libido dropped, and emotionally I felt somewhat flat. I noticed that I was less affectionate and emotionally expressive toward my wife than usual.
Switching to Abilify
Because of those side effects, my psychiatrist decided to discontinue Risperidone and replace it with Abilify at 5 mg daily.
The change was noticeable almost immediately.
My libido and sexual function improved significantly after making the switch. While Abilify works differently than Risperidone, both medications are commonly used as augmentation treatments for OCD.
One way of thinking about them is that they affect dopamine activity, which may help reduce the reinforcement that often drives compulsive behaviors.
So far, I feel better on the combination of Prozac and Abilify than I did on Prozac alone.
What I Am Noticing Now
Now that I have reached 80 mg of Prozac, I am beginning to notice more subtle improvements.
My intrusive thoughts seem less intense.
My compulsive urges are still present, but they feel easier to resist.
I can often go longer periods without acting on compulsions, even when the urges are still there.
These improvements are not dramatic, but they are meaningful.
I was never expecting a cure. My goal has always been to reduce the severity of the disorder and improve my quality of life.
The Biggest Side Effect
The biggest challenge I am currently facing is insomnia.
Since starting Abilify, I have often been sleeping only two to three hours per night. I wake up feeling restless and energized despite being exhausted.
My psychiatrist believes this may be related to the activating nature of Abilify and recommended taking it in the morning instead of at night.
I am currently testing that adjustment to see if it helps.
My Thoughts So Far
At this point, I do not believe I have given Prozac a full therapeutic trial at 80 mg. I still need more time before making any final judgment.
However, I am encouraged by what I have seen so far.
Compared to other SSRIs I have tried, Prozac has been easier for me to tolerate and has produced fewer side effects overall.
Most importantly, I am seeing gradual improvements in both intrusive thoughts and compulsive behaviors.
As I have said many times before, I believe OCD has both a biological and psychological component.
Medication can help address the biological side of the disorder, while ERP therapy helps address the psychological patterns that OCD creates.
For me, both approaches have been important.
I am not looking for perfection. I am looking for progress.
As I continue this treatment, I will provide future updates after I have spent more time at the therapeutic dose.