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Areas › Worry and anxiety › Obsessions and compulsions
The slow build is there to keep side effects bearable through the first few weeks, which is where most people quietly give up. It helps to agree with the prescriber in advance what you will do if those weeks are rough, so the plan is made while you are calm rather than at eleven at night. Coming off again later is its own decision and deserves the same care.
Obsessive thoughts and compulsions respond well to a specific kind of therapy. What is here is for understanding them, not for treating them by yourself.
God wishes to lighten your burden; man was created weak (Quran 4:28). Taking something that lightens the load sits comfortably with that, and is not a failure of resolve.
النساء
يُرِيدُ ٱللَّهُ أَن يُخَفِّفَ عَنكُمۡۚ وَخُلِقَ ٱلۡإِنسَٰنُ ضَعِيفࣰ ا
God wishes to lighten your burden; man was created weak
Qur’an 4:28read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
A network meta-analysis comparing adult treatments found that both psychological therapy and serotonin-reuptake medication beat placebo, with the behavioural therapies showing larger effects in trials that used non-active comparisons. A separate meta-analysis found that people who stopped an antidepressant after responding relapsed considerably more often than those who continued. Neither speaks to how high a dose is needed, so treat that part as clinical practice rather than something these studies show.
Skapinakis P, Caldwell DM, Hollingworth W, Bryden P, Fineberg NA, Salkovskis P, Welton NJ, Baxter H, Kessler D, Churchill R, Lewis G. (2016). Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults: a systematic review and network meta-analysis.. The lancet. Psychiatry doi
Batelaan NM, Bosman RC, Muntingh A, Scholten WD, Huijbregts KM, van Balkom AJLM. (2017). Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials.. BMJ (Clinical research ed.) doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Getting through the early weeks is what buys you the chance to find out whether it works at all.
Dose changes and stopping belong with the person prescribing, never worked out on your own.
What the thought is about matters far less than what happens next. Germs, illness, something too silly to say aloud: the machinery running underneath is the same in each case.
Plenty of people quietly believe that thinking about something bad makes it more likely to happen. It has a name, it is a known part of this condition, and having the belief does not make you dangerous.
Notice how when one worry is finally settled, another takes its place. That pattern is the thing you are actually dealing with, more than whichever worry is currently in the chair.