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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by umberto on October 7, 2008, at 10:23:15
I have been suffering from pure-O OCD for the last 15 years. For the first 12-13 years, one or the other SSRI managed to keep the problems at bay enough for me to get through academic life and then work. However, 2 years back, I stopped Lexapro (it was working very well, but I had put on a ton of weight) . I was off medicines for 3 months before I had a huge relapse. Since then, I have tried multiple SSRIs (as well as clomipramine) at high doses but nothing seems to work beyond 60-70% efficacy, which leaves me still significantly disabled and very highly anxious. The last 2 years have been very rocky, and I am completely confused on how to proceed since SSRIs are supposedly the only medicine for OCD.
Can someone relate to my symptoms and sudden med-resistance? I do not have any compulsions, and obsessions are non-content specific ( --- I am obsessed about obsessing , if that makes any sense --- ). I fear sporadic thoughts will arise in my mind which prevent me from attending with full focus on the task at hand. Therapy does not help. Doing anything - work, talking on phone etc. makes the anxiety shoot up. I am currently taking 2 mg clonazepam to combat anxiety, but it is doing a mild job at best, the anxiety is still significant.
Any medicine which acts on the NE system ups my anxiety significantly. Thus venlafaxine and clomipramine have been disasters. I responded to Paxil once but failed to respond the second time around.
If anybody has been in a similar position, what did you do to get out of it?
Thanks for ur help.
Posted by greywolf on October 7, 2008, at 12:17:43
In reply to Non-SSRI OCD Medications - Help Needed, posted by umberto on October 7, 2008, at 10:23:15
Wish I could give you some help, but SSRIs did not work at all for my OCD, and neither did Anafranil.
The most benefit I've received is from CBT, but you have to find a specialist in OCD therapy for it to work. And be prepared for it to take years because that's the nature of the beast.
Greywolf
Posted by Phillipa on October 7, 2008, at 12:23:22
In reply to Non-SSRI OCD Medications - Help Needed, posted by umberto on October 7, 2008, at 10:23:15
Umberto sounds like me although klonopin doesn't work for me used valium for too many years so now resistant to it. Never did anafranil but stay on low dose of luvox. Somehow I think I don't count anymore and add and substract as I used to. But can't stop obsessive worry so tired all the time. There must be something. Tried CBT for just anxiety. No go for me. Phillipa
Posted by azalea on October 7, 2008, at 15:42:59
In reply to Non-SSRI OCD Medications - Help Needed, posted by umberto on October 7, 2008, at 10:23:15
What you describe is termed tachyphylaxis in the literature. It has been reported in people taking SSRIs for depression. This leads me to believe that it likely occurs with SSRIs for OCD as well.
SSRIs are generally considered the foundation of OCD treatment, however it is not uncommon to achieve incomplete response with SSRI monotherapy. Perhaps you could consider an augmenting agent such as buspirone, an atypical antipsychotic, or lithium.
You could also try a different SSRI. Sometimes another one will work after one stops working. Fluvoxamine (Luvox) might be a good option.
There is also some evidence that inositol supplementation is effective for treating OCD. Doses used in studies ranged from 12-18 grams daily. You can get inositol supplements at health food stores or order from a vitamin store online.
Best wishes.
> I have been suffering from pure-O OCD for the last 15 years. For the first 12-13 years, one or the other SSRI managed to keep the problems at bay enough for me to get through academic life and then work. However, 2 years back, I stopped Lexapro (it was working very well, but I had put on a ton of weight) . I was off medicines for 3 months before I had a huge relapse. Since then, I have tried multiple SSRIs (as well as clomipramine) at high doses but nothing seems to work beyond 60-70% efficacy, which leaves me still significantly disabled and very highly anxious. The last 2 years have been very rocky, and I am completely confused on how to proceed since SSRIs are supposedly the only medicine for OCD.
>
> Can someone relate to my symptoms and sudden med-resistance? I do not have any compulsions, and obsessions are non-content specific ( --- I am obsessed about obsessing , if that makes any sense --- ). I fear sporadic thoughts will arise in my mind which prevent me from attending with full focus on the task at hand. Therapy does not help. Doing anything - work, talking on phone etc. makes the anxiety shoot up. I am currently taking 2 mg clonazepam to combat anxiety, but it is doing a mild job at best, the anxiety is still significant.
>
> Any medicine which acts on the NE system ups my anxiety significantly. Thus venlafaxine and clomipramine have been disasters. I responded to Paxil once but failed to respond the second time around.
>
> If anybody has been in a similar position, what did you do to get out of it?
>
> Thanks for ur help.
Posted by Amigan on October 8, 2008, at 1:42:51
In reply to Non-SSRI OCD Medications - Help Needed, posted by umberto on October 7, 2008, at 10:23:15
Posted by umberto on October 8, 2008, at 11:40:49
In reply to Re: Non-SSRI OCD Medications - Help Needed » umberto, posted by azalea on October 7, 2008, at 15:42:59
> What you describe is termed tachyphylaxis in the literature. It has been reported in people taking SSRIs for depression. This leads me to believe that it likely occurs with SSRIs for OCD as well.
>
> SSRIs are generally considered the foundation of OCD treatment, however it is not uncommon to achieve incomplete response with SSRI monotherapy. Perhaps you could consider an augmenting agent such as buspirone, an atypical antipsychotic, or lithium.I have tried risperidone but it made my mind totally foggy and made me zombie-like. Is there any other atypical antipsychotic that you feel would help, particularly with the anxiety?
I am curious, why do you suggest lithium?
>
> You could also try a different SSRI. Sometimes another one will work after one stops working. Fluvoxamine (Luvox) might be a good option.I have tried all the SSRIs in the past 2 years, including Luvox. Improvement beyond 60-70% is not forthcoming.
>
> There is also some evidence that inositol supplementation is effective for treating OCD. Doses used in studies ranged from 12-18 grams daily. You can get inositol supplements at health food stores or order from a vitamin store online.Inositol is a B-complex vitamin, how does that help OCD or anxiety.
>
> Best wishes.Thanks for ur time.
Umberto
>
> > I have been suffering from pure-O OCD for the last 15 years. For the first 12-13 years, one or the other SSRI managed to keep the problems at bay enough for me to get through academic life and then work. However, 2 years back, I stopped Lexapro (it was working very well, but I had put on a ton of weight) . I was off medicines for 3 months before I had a huge relapse. Since then, I have tried multiple SSRIs (as well as clomipramine) at high doses but nothing seems to work beyond 60-70% efficacy, which leaves me still significantly disabled and very highly anxious. The last 2 years have been very rocky, and I am completely confused on how to proceed since SSRIs are supposedly the only medicine for OCD.
> >
> > Can someone relate to my symptoms and sudden med-resistance? I do not have any compulsions, and obsessions are non-content specific ( --- I am obsessed about obsessing , if that makes any sense --- ). I fear sporadic thoughts will arise in my mind which prevent me from attending with full focus on the task at hand. Therapy does not help. Doing anything - work, talking on phone etc. makes the anxiety shoot up. I am currently taking 2 mg clonazepam to combat anxiety, but it is doing a mild job at best, the anxiety is still significant.
> >
> > Any medicine which acts on the NE system ups my anxiety significantly. Thus venlafaxine and clomipramine have been disasters. I responded to Paxil once but failed to respond the second time around.
> >
> > If anybody has been in a similar position, what did you do to get out of it?
> >
> > Thanks for ur help.
>
>
Posted by desolationrower on October 8, 2008, at 13:23:50
In reply to Re: Non-SSRI OCD Medications - Help Needed, posted by umberto on October 8, 2008, at 11:40:49
Lithium has some effects on serotonin, but different from the ssris. I think it affects the 1b autoreceptors and maybe some other things.
Inositol is a secondary messanger is some neurons. It can affects the sensitivty of some serotonin receptors. It has been effective for some of the same things as ssri are.
Personally, for trying antispychotics, especially if you feel you might need to be on it permanently once you find one that works, i would start with the ones with fewer side effects like aripiprazole and ziprasidone and work my way from there. I don't think i've seen anything show one to work better than another.
Some other options are opiods, MAOIs, stimulants, and some glutamatergic drugs, like memantine and n-acetyl cysteine.
If you gave the noradrenergic drugs enough time to work, as they seem to take longer for anxiety to be effective, a beta blocker might help you with anxiety, and i'd recommend pindolol since it has effects on serotonin as well.
-d/r
Posted by azalea on October 8, 2008, at 16:20:27
In reply to Re: Non-SSRI OCD Medications - Help Needed, posted by umberto on October 8, 2008, at 11:40:49
> Inositol is a B-complex vitamin, how does that help OCD or anxiety.I don't know how inositol helps OCD, but the study below showed good results.
Am J Psychiatry. 1996 Sep;153(9):1219-21.
Inositol treatment of obsessive-compulsive disorder.
Fux M, Levine J, Aviv A, Belmaker RH.
Ministry of Health Mental Health Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheva, Israel.OBJECTIVE: Earlier studies reported that inositol, a simple polyol second messenger precursor, was effective in controlled trials for patients with depression and panic. In this study its effectiveness in obsessive-compulsive disorder was investigated. METHOD: Thirteen patients with obsessive-compulsive disorder completed a double-blind, controlled crossover trial of 18 g/day of inositol or placebo for 6 weeks each. RESULTS: The subjects had significantly lower scores on the Yale-Brown Obsessive Compulsive Scale when taking inositol than when taking placebo. CONCLUSIONS: The authors conclude that inositol is effective in depression, panic, and obsessive-compulsive disorder, a spectrum of disorders responsive to selective serotonin reuptake inhibitors.
Posted by azalea on October 8, 2008, at 16:34:28
In reply to Re: Non-SSRI OCD Medications - Help Needed, posted by umberto on October 8, 2008, at 11:40:49
Some other options for non-SSRI medications for OCD
-trazodone
-clonazepam
-buspirone
-MAOIs such as phenelzine (Nardil)
Posted by Kimbersaur on October 8, 2008, at 16:55:30
In reply to inositol for OCD » umberto, posted by azalea on October 8, 2008, at 16:20:27
15 grams of inositol helped me with intrusive thoughts, but not with any other OCD issues as far as I can tell
This is the end of the thread.
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