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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on February 1, 2015, at 15:50:34
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 1, 2015, at 15:39:09
>Risperidal also caused bad salivation which was unpleasant
Dopamine antagonists can cause hypersalivation, but to experience it at such a low dose is unusual. It's more commonly seen with high doses of older neuroleptics such as haloperidol. In fact, you could be extremely sensitive to haloperidol, so it may be a good idea to avoid it entirely for now.
>tics...
Clonidine, which is sometimes used to suppress tics, also appears to acutely reduce OCD symptoms - even after a single dose. Whether it has any sustained effectiveness in OCD is unknown. Assuming you do not have low blood pressure, you could potentially try it.
http://www.ncbi.nlm.nih.gov/pubmed/1876628
'Following clonidine, but not following placebo, patients transiently experienced a significant reduction of obsessions and compulsions.'
Posted by ed_uk2010 on February 1, 2015, at 15:54:15
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 1, 2015, at 15:39:09
I can see why you'd be cautious about trying further SSRIs if prolonged vortioxetine treatment was ineffective.
Since clonidine appears to work rapidly, I wonder what your doctor would think of trying it? In psychiatry, it's mainly used for tic disorders, and occasionally for reduction of hyperactive/impulsive behavior, but prescribing for other uses does occur. Clonidine was traditionally used for high blood pressure but has been replaced by other medications for this purpose.
Posted by ed_uk2010 on February 1, 2015, at 15:57:32
In reply to Re: OCD Dont know where to go, posted by ed_uk2010 on February 1, 2015, at 15:50:34
Anyway, has any of this helped you feel a bit of optimism about treatment options?
Posted by Bill82 on February 1, 2015, at 20:00:23
In reply to Re: OCD Dont know where to go, posted by ed_uk2010 on February 1, 2015, at 15:57:32
Yea you've been a great help I've been eager to check my email all day haha thanks a lot man! As for clonidine I have thought of it, I do have slight low bp due to pots syndrom, but at this rate that is not a deterant, I'll just have to eat more salt. Little worries about impotence but that's just my ocd talking. Too bad ocd dosnt have more options besides ssris in literature. I was just reading a paper on how opiates are particularly effective in ocd with tics, and I can certainly say the morphine they gave me in the hospital obliterated my ocd and especially my doubt which was great. But we know where that goes.
Posted by ed_uk2010 on February 2, 2015, at 6:58:24
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 1, 2015, at 20:00:23
> Yea you've been a great help I've been eager to check my email all day haha thanks a lot man!
Oh that's good!
>As for clonidine I have thought of it, I do have slight low bp due to pots syndrome, but at this rate that is not a deterant, I'll just have to eat more salt.You wouldn't necessarily need to eat more salt. Clonidine does not always cause much postural BP drop, you would have to try it and find out. It tends to reduce heart rate slightly. So long as you started with a low dose and adjusted cautiously it should not be dangerous. After long term use, clonidine needs to be withdrawn gradually.
>Little worries about impotence but that's just my ocd talking.
If you do find an effective treatment and suffer erectile dysfunction you could always use sildenafil or similar. I get the impression that with the current severity of your OCD it would be difficult to put erections to good use anyway, so you may as well concentrate on dealing with the OCD first.
>I was just reading a paper on how opiates are particularly effective in ocd with tics, and I can certainly say the morphine they gave me in the hospital obliterated my ocd and especially my doubt which was great.
Effective briefly but you need something long term. Furthermore, extended use would probably lead to hormonal disturbances and more erectile dysfunction.
Posted by Bill82 on February 2, 2015, at 10:17:30
In reply to Re: OCD Dont know where to go, posted by ed_uk2010 on February 2, 2015, at 6:58:24
Any thoughts on naltrexone? There's one study that found it to be useful. I don't think it would cause hormonal imbalances but I could be wrong
Posted by ed_uk2010 on February 2, 2015, at 11:13:41
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 2, 2015, at 10:17:30
> Any thoughts on naltrexone? There's one study that found it to be useful. I don't think it would cause hormonal imbalances but I could be wrong
Naltrexone is an opiate blocking drug. It may be helpful for impulse control disorders eg. pathological gambling, but I don't think it's normally helpful for OCD.
How are you doing today?
Posted by Bill82 on February 2, 2015, at 11:22:41
In reply to Re: OCD Dont know where to go, posted by ed_uk2010 on February 2, 2015, at 11:13:41
Yea that's what i figured. Ocd is pretty bad, drs keep canceling my opointments so just waiting really to get back to them and see what they say. I kind of think they are running out of potential things to try and are kind of fillabusting, but I could be weong( I hope I am actually haha).
Posted by Bill82 on February 2, 2015, at 11:24:50
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 2, 2015, at 11:22:41
Some new compulsions are starting to suchc as saying stop when I have bad thoughts and suddenly stopping when walking because something dosnt feel right. Weird disease
Posted by Bill82 on February 2, 2015, at 11:25:30
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 2, 2015, at 11:24:50
How are you doing recently?
Posted by ed_uk2010 on February 2, 2015, at 12:10:25
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 2, 2015, at 11:25:30
I'm not too bad thanks, things are reasonable. I have side effects from a lot of meds but not too many from SSRIs. Mind you, I have been on one or another for almost two decades, plenty of time to get used to them.
I suppose the advantage of saffron is that you can start treatment yourself. It is rather expensive though....
Posted by Bill82 on February 2, 2015, at 17:47:19
In reply to Re: OCD Dont know where to go, posted by ed_uk2010 on February 2, 2015, at 12:10:25
Glad you are feeling ok, side effects are a real pain. I just ordered some so I'll have to try it out. Have you ever heard of tianeptine?
Posted by Michael Bell on February 2, 2015, at 22:43:56
In reply to OCD Dont know where to go, posted by Bill82 on January 30, 2015, at 20:56:23
Take it from someone who had extreme hypochondriasis and obsessive/ruminative tendencies. I've been on everything. For daily medication, nothing works better than clomipramine. For anhedonia/low mood/OCD, ketamine infusions are damn near miraculous.
Posted by ed_uk2010 on February 3, 2015, at 6:36:02
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 2, 2015, at 17:47:19
>Have you ever heard of tianeptine?
Yes. I've never been on it but I am familiar with it.
Posted by Hugh on February 4, 2015, at 11:42:29
In reply to OCD Dont know where to go, posted by Bill82 on January 30, 2015, at 20:56:23
Deep TMS press release:
The double-blind, placebo-controlled study involved a total of 25 OCD patients that had previously failed to respond to both pharmacological and psychological therapy.
The clinical results showed an average improvement of 27% in symptoms of patients in the high-frequency treatment group, which was significant relative to the sham-control treated group (p=0.0003).
From Yale Daily News:
Researchers at the Yale School of Medicine studying obsessive-compulsive disorder are moving closer to personalizing treatments to individuals brains.
The researchers are the first to use functional Magnetic Resonance Imaging to predict whether neurofeedback a technique in which patients are shown a real-time graph of their brain activity while they experiment with various treatment techniques will work for certain patients. Using 13 patients, researchers found that individuals with a stronger connection between the orbitofrontal cortex, a region responsible for decision making that also becomes hyperactive when people become abnormally anxious about dirt and grime, and the rest of the brain respond better to neurofeedback.
Some people will have a certain brain pattern and respond to certain types of treatment, while others will have a different brain pattern and respond to different types of treatment, senior author and assistant professor of diagnostic radiology at the Yale School of Medicine Michelle Hampson said.
http://yaledailynews.com/blog/2014/10/21/neurotherapy-more-successful-for-some
Posted by Louisiana Sportsman on February 6, 2015, at 14:47:02
In reply to OCD Dont know where to go, posted by Bill82 on January 30, 2015, at 20:56:23
This is such a great thread!
I would suggest buprenorphine therapy, it could help. But consider Pregabalin first. Or a really slow taper of Anafranil.
Posted by Bill82 on February 7, 2015, at 3:04:59
In reply to Re: OCD Dont know where to go, posted by Louisiana Sportsman on February 6, 2015, at 14:47:02
Thanks for the responses guys, dug up some interesting info on berberine, a sigma agonist that has a lot of other benifits and seems to be anoloxcic and anti depressive. From the roots of some common plants such as barberry(gives it the yellow color). Might get some...
Posted by Bill82 on February 7, 2015, at 3:38:58
In reply to Re: OCD Dont know where to go, posted by Louisiana Sportsman on February 6, 2015, at 14:47:02
Never mind berberine is used in prostate cancer haha, will pass on it for now then!
Posted by Bill82 on February 9, 2015, at 14:13:42
In reply to Re: OCD Dont know where to go, posted by Louisiana Sportsman on February 6, 2015, at 14:47:02
This article is interesting. Although when not on an ssri I don't experience depression, it may offer insight into how I get seemingly anticholinergic side effects from ssri. Just a thought.
Posted by ed_uk2010 on February 10, 2015, at 12:16:14
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 9, 2015, at 14:13:42
Thanks for posting.
So, have you made any changes to your meds?
Posted by phidippus on February 10, 2015, at 15:48:45
In reply to OCD Dont know where to go, posted by Bill82 on January 30, 2015, at 20:56:23
First off, first line treatment for OCD is not medication, but ERP (exposure and response prevention). Its not easy to do, but if done properly, can curb even the worse ideations.
Second line treatment of OCD is treatment with a serotogenic drug. OCD involves lowered levels of serotonin in certain areas of the brain. Because of the physiology of OCD, you can't really treat it with anything else-unless you're using anti-glutamatergic drugs or antipsychotics to augment treatment with an antidepressant.
You described the medications you were on and I'm noticing a couple of trends with the antidepressants you've taken. Most or all of them caused an imbalanced emotional state: Mirtazapine, Luvox, Zoloft, Lexapro, Brintellix. This could be an indication of bipolar disorder, in which case you will need treatment with a mood stabilizer before you treat the OCD with an antidepressant.
Once you've treated the OCD with an antidepressant and you don't have the response you want, you'll want to augment with an antipsychotic (never take an antipsychotic alone to treat OCD-it'll just make it worse). The reason you want to augment with an antipsychotic is because OCD involves high levels of dopamine in certain parts of the brain, most notably the nucleus accumbens. Together the antidepressant and the antipsychotic will work together to lessen symptoms.
If you still don't have enough response to the antidepressant and the antipsychotic, it is advised that you add a anti-glutamatergic agent like Riluzole, Keppra, Zonegran, Topemax or Lyrica.
When you take antidepressants, typically, how long are you on them before you stop them because of side effects?
I too have severe OCD and have been able to conquer it with the right mix of medications and therapy. Write me back if you have any questions.
Eric
Posted by phidippus on February 10, 2015, at 15:51:37
In reply to Re: OCD Dont know where to go, posted by Bill82 on January 31, 2015, at 16:03:55
>I was about to try pregabalin but p doc decided against it die to adverse reactions to other GABA meds(benzos and lamictal).
Pregablin has nothing to do with GABA. It is a Calcium Channel blocker and glutamate antagonist. It would be ideal for treating your OCD.
Eric
Posted by phidippus on February 10, 2015, at 16:01:16
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 1, 2015, at 13:10:41
>Zoloft was at 50mg for 3 days haha.
It takes about 4-6 weeks for SSRIs to become effective.
Eric
Posted by phidippus on February 10, 2015, at 16:12:41
In reply to OCD Dont know where to go, posted by Bill82 on January 30, 2015, at 20:57:31
Have you done ERP?
Eric
Posted by Bill82 on February 10, 2015, at 18:05:01
In reply to Re: OCD Dont know where to go » Bill82, posted by phidippus on February 10, 2015, at 16:01:16
Yea they had discussed the bipolar stuff with the doc, but when I'm not on any meds at all as I am now, I don't have depression at all and have never been manic or overly attentive, irritable, creative ect. So not sure why I would treat something that dosnt exist in the first place. As for the the gabapentin, she said it not me haha, and I noticed from the begining she seemed kind of daft in terms of understanding the science. (Ex: giving the car fluid example for why you have ocd, inferring I'm running low on seritonin and it's that simple.) as for erp, I already do that on my own time but it is not enough, as when exsposing myself to the stimulus and resisting my compulsions, which I do a lot, it causes a lack of motivation and zest for life that I had before(ex: not doing my rituals I then feel like a piece of crap, I don't have any desire to do anything to) . Only residual symptom psychologically I have that I didn't have before is an inanity to pay attention to a certain task, in that I space out or get distracted, and not from my ocd, but from other things. As for the zoloft I know 3 days would do squat, but the effects I had from it made me quit early because I simply couldn't take it. But still not sure what to as ssri make me sad and blue(what they do mentally is make me brush off the thoughts and then I feel like crap similar to erp) antipsychotics as you said do nothing on their own. Really what I would like is to find away to remove some of the extreme inability to have confidence in anything, but most people say that's impossible sadly.
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