Obsessive Compulsive Disorder

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. Check www.whelehans.ie for more information. If you have any health questions e-mail them to info@whelehans.ie

This information piece gives a brief outline of Obsessive-compulsive disorder (OCD). Check out www.whelehans.ie or call into Whelehans Pharmacy for more detailed information on OCD. If you feel you suffer from OCD, I would advise discussing your concerns with your GP in confidence and he/she will advise you on the best course of action to take (if any). Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder of varying degrees of severity and it is characterised by obsessions or compulsions but commonly both. Obsessions are unwanted intrusive thoughts, images or urges that occur repeatedly and the person cannot get out of their mind. Compulsions are repetitive behaviours or mental acts that the person feels driven to carry out.

How common is OCD?

1 to 2% of the population are thought to suffer from OCD, although some studies suggest it is as high as 2 to 3%. OCD appears to be more common in women than men. OCD is sometimes linked to depression and about 50% of people suffering from OCD may also have depression.

Symptoms

Obsessions

Examples of obsessions include fear of causing harm to someone else; fear of harm coming to self; fear of contamination; need for symmetry or exactness; sexual and religious obsessions; fear of behaving unacceptably and fear of making a mistake

Compulsions

Compulsions can include behaviours such as cleaning, hand washing, checking, ordering and arranging, hoarding and asking for reassurance. Compulsions can also include mental acts such as counting, repeating words silently and constant worries about past events.

Treatment

Psychological therapy such as counselling and Cognitive Behavioural Therapy appears to be the most effective treatment option for OCD. Check out www.whelehans.ie for more info on psychological treatment of OCD.

Medication may be needed in some cases. Antidepressants called Serotonin Selective Reuptake inhibitors (SSRIs) appear to be effective for OCD. SSRIs such as fluoxetine, sertraline or citalopram can be prescribed for OCD. There are no significant differences in efficacy between the different SSRIs for OCD. Higher doses of SSRIs than those used for depression may be needed to effectively treat OCD. For example, fluoxetine dose may be increased to up to 60mg for OCD. GPs often refer people to psychologists who specialise in OCD to ensure the best possible treatment options.

OCD Ireland is a national organisation for people with Obsessive Compulsive Disorder (OCD). Their website is www.ocdireland.org and it provides great information and advice on OCD. The website also lists psychiatrists in Ireland who provide treatment of OCD.

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This article is shortened. For more detailed information, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

Sleeping tablets

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. Check www.whelehans.ie for more information. If you have any health questions e-mail them to info@whelehans.ie

Sleeping medication should be absolute last resort. I discussed in a previous blog natural ways to help aid sleep; to read this click on: http://whelehans.blogspot.com/2015/01/insomnia-and-its-management.html

Quite often sleep disturbance is due to a medical condition. Examples include depression, asthma, ADHD or pain. Treating the medical condition is often the key to solving the sleep problem.

Natural Products

There are many natural products available. Their effectiveness is questionable and will only help mild insomnia (if at all). In Whelehans, we find that products containing Valerian (a natural sedative) aids sleep for some. Ask our staff for details of products we stock containing valerian.

Prescription medication

Prescription sleeping medication should only be used for short term use. It is easy to become dependent on them and they become less effective if used for more than 5 days. A doctor may consider the short term use of sleep medication if the symptoms are particularly severe, to ease short-term insomnia, or if the non-drug treatments failed. Doctors try to rule out other medical problems such as depression before prescribing sleeping tablets. Prescription sleeping tablets will temporarily relieve symptoms but do not tackle the cause. You should be given the lowest dose possible for the shortest length of time necessary (no longer than 5 days). The doctor may advise to only take the medication two or three nights a week, rather than every night.

Prescription hypnotic medicines cause side effects including a hungover feeling and drowsiness the next day. Sleeping medication are best taken half an hour before bedtime. In some, especially older people, the hangover effects may last well into the next day, so be cautious if driving or using machinery the next day. It is very easy to become dependent on these medicines, even in the short-term. If regularly taking sleeping tablets, you should consider reducing or stopping them. If you have been taking long term, do not stop them suddenly, as withdrawal symptoms can include panic attacks, shaking and rebound insomnia. Your doctor or pharmacist will give you advice safe withdrawal.

Types of prescription sleeping tablets

Benzodiazepines

Benzodiazepines are tranquillisers designed to reduce anxiety and promote calmness, relaxation and sleep. These medicines should only be considered if insomnia is severe or causing you extreme distress. All benzodiazepines make you feel sleepy and can lead to a dependency. If they are needed to treat insomnia, then only short-acting benzodiazepines (with short-lasting effects) should be prescribed, such as temazepam (Nortem^®, Insomniger^®), lormetazepam (Noctamid^®), flurazepam (Dalmane^®), triazolam (Halcion^®). As someone who has seen too often the terrible problems addiction to benzodiazepines cause, I advise they should be an absolute last resort.

Non benzodiazepines

The newer non benzodiazepine sleeping tablets such as zopiclone (Zimovane^®, Zimoclone^®) and zolpidem (Stilnoct^®, Zolnod^®) are less addictive than older varieties but it is still easy to become dependant on them. They tend to cause a metallic in the mouth. There is little difference (efficacy wise) between the non-benzodiazepines and older benzodiazepines, so if one does not work, it is unlikely that swapping to another will have a different effect. Sleeping tablets are best avoided in the elderly if possible as they cause confusion and increase the likelihood of falls.

Antidepressants
Some older antidepressants such as amitriptryline and trazodone are sometimes used to treat insomnia as they induce drowsiness. They should only be used in patients suffering from insomnia caused by depression. They are generally only prescribed under the supervision of a consultant psychologist. These older antidepressants can have more side effects than newer antidepressants such as dry eyes and mouth and constipation. Newer antidepressants that do not cause side effects such as drowsiness are more regularly used in depression. However in most cases, by treating the depression (combination of lifestyle changes, counselling, medication if need be), the sleeping pattern should then soon improve. 

Melatonin
Melatonin is a natural chemical produced by the pineal gland in the brain. Its key functions in the body are to induce sleep by causing drowsiness and lowering temperature. Melatonin has been available to purchase over the counter as a sleep aid in the US for over 15 years. However, it has only recently been launched on prescription in Ireland under the brand name Circadin^®. It can only be prescribed by a doctor and is only licensed for short term use in people over 55 and should not be taken for more than three weeks. It is not recommended for people with a history of kidney or liver disease. As Circadin^® can make you feel drowsy; you should not drive or operate heavy machinery after taking the medicine at night, or if you still feel drowsy the next morning. Side effects of Circadin are uncommon but include irritability, dizziness, migraines, constipation, stomach pain, and weight gain. Circadin^® does not have a GMS code meaning it is not allowed on the medical card or drug payment scheme.

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