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  1. Dear sir/madam, I'm 50. Since childhood I suffered from symptoms of ocd, axiety, intrusive thoughts. In 1987, age 20, I was diagnosed and given clomipramine after experiencing acute panic attack, since then I switched to many other trycyclics along with bezodiezepines. In 1988 I was treated with ECT as well. In 1991 I was given fluoxetine along with clomipramine and dexfenfluramine(isomeride)plus cognitive behavioural therapy(exposer therapy), for a couple of months I was also given phenelzine(Maoi) in 1996, symptoms and disturbance hardly improved, bouts of panic attack returned after every couple of years. In 1997 I was prescribed with sertraline, I must say however that since then panic attacks have hardly returned and felt life better, compulsive behaviour and anxiety subsided but intrusive thoughts remained. However I would like to admit this as a partial recovery. 20 years since I would like to wean from the medication but afraid that panic attack could return because once it happened. On the other hand I also read in the web that a refractory depression or ocd could be treated with supratherapeutic medication to bring better result, that is to say that, to add extra or double the amount of doses than normaly recomended. I'm now on 100mg sertraline which was incleased from 50mg about a two months ago. I have also read about serteraline associated hepatotoxicity and mitochondrial impairment may play an important role in liver injury induced by sertraline. Though 20 years on sertraline I have been tested negative for all the abnormal parameters for lever function from the periodical lever function blood test. My concern is also that if I'm given a supratherapeutic medication with sertraline: say from maximum recomended dose of 200mg to gradually 400mg/day could my normal parameters for lever function go abnormal? or could there be any alternative to treat my refractory ocd? ? looking forward to have your say. Thanks for reading.
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