This community looks pretty dead, so I'm gonna post in the hope of livening it up a bit. I'd love to hear about the efforts other people are making to remove the burden of OCD from their lives.

TL;DR: I am starting to think Fluoxetine may actually be having a noticeable positive effect, and I would like to encourage anyone with reservations about SSRIs, or who may be thinking of giving up on it, to give it a chance.

Talk therapy and CBT have never really made a significant or lasting impact on the mental blocks OCD creates for me on a daily basis. I put off trying Fluoxetine for a very long time, solely because of an absolutely horrendous experience I had with another SSRI (Venlefaxine) many years ago. The time I was on it was almost as bad as the weeks I spent weaning off it. After reading a lot of posts from other people comparing SSRI experiences, and seeing Venlefaxine consistently ranked the lowest in efficacy and highest in side–effects, I started to feel a bit more confident about starting Fluoxetine. I'd reached a point in my life where a combination of factors had made life a living hell as well, so I was at peak "fuck it, might as well".

I started at 10mg a day. My directions were to continue that for the first week, then step up to 20mg. Like an idiot, I decided to speedrun to 20 on my third day. Also like an idiot, I decided to take it the moment I woke up, and put off eating until a couple of hours later. Two lessons quickly were learned from this.

• Fluoxetine has a long half life, and the reason you start low is because your body is adjusting to an accumulation of the drug over the course of the week. Rapidly increasing your dose will also rapidly increase the onset of the side–effects one feels while adjusting to the drug. This includes an increase of the symptoms the drug is ultimately supposed to suppress. My anxiety was off the charts. I was in fight–or–flight mode from late morning to well into the night, stomach in knots, and sleeping extremely poorly, if at all. It should be the most obvious advice, but for anyone else prone to stupid decisions like the ones I make, please take the drug as directed.

• Your stomach may also need time to adjust to the drug. This probably won't apply to everyone, but I personally regretted taking it on an empty stomach so much that I made that mistake exactly once, and now ensure that I have at least a little bit of something in me before I take my pill. If you do fuck up like I did, I recommend a ginger capsule and an antacid. Seemed to calm my stomach down enough to at least stop writhing around in pain for the rest of the afternoon.

On to the positives now. I'm on day 18, still taking 20mg Fluoxetine XR each morning after breakfast. By all accounts, this is still quite early in the adjustment period for this drug. Most people report an awareness of the intended effect, while still experiencing some of the unpleasantness such as fatigue, nausea, and anxiety. This is consistent with what I'm going through right now. It sounds a bit nonsensical, but while I do feel an unshakeable sense of dread, and I am having bouts of inexplicable irritability, I'm also distinctly aware of my new ability to shake off the anguish of everything being "wrong". Things not happening in the right order, things being in the wrong place, making a minor mistake — in reality these mistakes are just minor deviations from an established, arbitrary process — are easier to move past. I'm able to say "oh well" to stuff that could have completely derailed my day prior to starting this drug.

One thing that really gets me down at the moment is the fatigue. My sleep issues are seemingly calming down. I find it easy enough to get a continuous 6 hours, which for me is pretty huge. I wake up with a spring in my step and get a lot done in the first few hours, but by 6 hours in I'm faced with a choice of either taking a nap or dragging myself through what remains of the day, fantasising about just curling up and switching off. Again, this seems common, with most saying it goes away after 6 weeks, and a minority saying it took them a couple of months. I'm pinning all my hopes on having this same experience. I'm following up with my doctor tomorrow to discuss my dosage, and whether the fatigue could be mitigated in the short term with Bupropion (Wellbutrin), as it commonly is for people in my position.

The key takeaway is that Fluoxetine is a hellish drug to start out on, as all SSRIs seem to be, but it really seems to be making me not only less depressed, but less obsessively compulsive. I encourage others to consider it, even if they've had poor experiences with SSRIs in the past. However, if you're working full time, try to get some time off in your second and third week. If you can't, start out with the lowest possible dose and increase very slowly. I am not employed currently, and can't imagine holding down any job in this state.

HRT day 17.

I always wanted to be more social. I cared about people, wanted to know them more deeply, and wanted them to know me. I just never enjoyed the experience because I felt that the time people spent on me was an arduous act of charity that they endured for my sake, out of politeness and perhaps pity. I therefore kept to myself, unintentionally presented a pretty hard exterior that made me seem abrasive and antisocial, and spent nights wishing I could be closer to people around me. I was ashamed of who I was, and ultimately faded out of the lives of everyone I met sooner or later, once I felt I'd revealed too much of myself to put them through any more. It was lonely, and worst of all, many of these people continued trying to reach out while I sequestered myself and waited for the guilt to subside.

Short of growing breasts and marked shifts in fat distribution that I likely won't see for many months, I can never be sure what's an estrogen thing, what's a placebo thing, and what's just a good mood, but the last few days have been an unprecedented shift in my overall outlook. I talk honestly with people. I opened up to my mother about deeply personal things that I've kept guarded for decades. I message people just to ask if they're doing okay and if they want to catch up over coffee some time, and without even cringing at myself for doing so.

Today I've been thinking a lot about how remarkable it is to simply feel like I'm allowed to exist in the world, and allowed to be part of other people's lives. This isn't me. Except it is, and I hope it stays this way forever.