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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by crittercuddler on December 13, 2008, at 6:41:10
Hello all, I am a new member. I have been reading posts for hours so I hope this comes out coherently.
I have severe OCD and major depression, suicidal in nature. I have been unable to obtain relief in the last several years due to the following:
1. I USED to take Celexa, 60mg for the OCD and depression. I took it from Fall of 2001 until December of 2005 at which point I stopped it after completing a taper. I stopped it with the intention of getting on another anti-depressant because I felt the Celexa had lost its effectiveness. (I have since wondered if perhaps the fact that it went generic around the time I first noticed it was losing its effictiveness might have had something to do with it, but it is a moot point now.) When I was on it and it was "working" it only worked partially. It took the edge of my obsessions and slightly helped my depression. I was by no means cured, but it did help me function at a much higher level than I am able to without any medication.
2. Ok, SINCE getting off the Celexa I have not been able to tolerate any other SSRI for more than a couple of days and rarely, for a few weeks, before I had to stop because of the following side effects:
a. awful insomnia, helped only by Seroquel ***b. severe restless feeling, but I don't feel
well enough to do anything about it so I it is very uncomfortablec. obliterates my ability to concentrate or keep my train of thought (it feels like rocket science to straighten out my purse)
d. short term memory difficulties
e. myoclonic jerking when trying to sleep. (this is new and started since I have gotten off of Klonopin) The jerks whenever I try to relax or go to sleep. I will get a jerk everytime I start to drift off. This complicates the insomnia, making any chance I had of getting to sleep go away.
*** I tried 5mg of Prozac and it made me tired. Isn't that odd as it is supposed to be stimulating, right? I discontinued the 5mg because I was getting the other side effects that I mentioned.I have tried tiny doses of the SSRIs and I get the same awful side effects, even at 5mg of Zoloft, 5mg of Paxil, 2.5mg of Celexa... It is insane.
The fact that I can no longer tolerate an SSRI is very strange considering the fact that I took one for several years. Yes? As soon as I finished my Celexa taper I tried a new one and I couldn't handle it. Since then I have been banging my head up against the wall trying them to get on any one of them over and over and over again. What on earth happened?
I desperately need to get stabilized on a medicine, but I have been trying unsuccessfully for 3 miserable years now to do so because of what I mentioned above. I am not able to work or go to school and my functioning has been all but reduced to zero. I am persistently suicidal and living in utter misery. My OCD is out of control. And on top of all that I am still suffering from benzodiazepine withdrawal syndrome.
I am hoping that someone on this forum has had a similar experience and might be able to offer some advice on what medicines I might consider other than the SSRIs as they seem to not be an option for me. Please keep in mind my diagnoses of OCD and major depression.
Posted by crittercuddler on December 13, 2008, at 8:01:32
In reply to Sick newbie w/ bad OCDcan't tolerate an SSRI. HELP, posted by crittercuddler on December 13, 2008, at 6:41:10
Do I need to explain how my OCD manifests itself?
It is very obsessional in nature. The only outward signs you might see would be my over-vigilance, perfectionism at projects, and endless researching on the computer. Most all of my problem goes on in my head where no one can see it. My OCD therapist taught me that I have mental compulsions, which have names, but that I won't go into. Those that have the know what they are....
Some of my biggest obsessions include revolve around the fear of losing my mental abilities, like my creativity, memory, and intelligence. I can't do anything without constantly assessing my mental functions. I therefore do a lot of mental checking which is a compulsion you can't see. It steals all the joy from the precious present moment.
I have severe obsessions about failing or accidentally causing harm to someone, of course related to me being somehow inferior intellectually.
I often find that my mind gets stuck thinking over mundane things... like an insignificant conversation I had with someone or some random thing that happened during the course of a day. I get stuck in these awful thought loops that I can't escape. Even when I feel like I have come to a conclusion my brain just short circuits or something and I start thinking about it all over again. And of course when I am confronted with a problem that really demands my attention or that is worth thinking about I REALLY obsess.
My OCD has changed a lot in the 14 years I have had it. When I first developed it I had extreme germ phobias and ego alien thoughts.
Well, that is just a wee bit about my OCD to give you an idea of what it is like. I just wanted to clarify that I don't have counting compulsions or rituals or anything like that.
Posted by llurpsienoodle on December 13, 2008, at 8:45:54
In reply to Re: Sick newbie w/ bad OCDcan't tolerate an SSRI. HELP, posted by crittercuddler on December 13, 2008, at 8:01:32
hi cc,
welcome to babble!
I have a few thoughts. I am by NO means an expert on any of this stuff. I've had plenty of depression, often with ruminative thoughts, but not OCD proper.Have you tried any of the next-generation anti-psychotics? you mentioned seroquel for sleep?
abilify,
risperdol
geodon
...These helped me with my runaway thoughts, on many occasions.
Lamictal is a mood stabilizer that has antidepressant properties, or so my pdoc claimed. Well, at any rate, it doesn't make me MORE depressed, and certainly helps make the antidepressants more tolerable.
have you tried wellbutrin? it is not an ssri, and is quite effective for many.
I encourage you to give all the meds you try a good 6 week trial. for me, with seroquel, I was comatose on (200mg) for about 2 weeks. Then my body gradually started getting used to it, and within 5 weeks, I could wake up and feel normal.
sorry you're feeling bad right now,
-Ll
Posted by crittercuddler on December 13, 2008, at 14:33:43
In reply to Re: Sick newbie w/ bad OCDcan't tolerate an SSRI. HELP » crittercuddler, posted by llurpsienoodle on December 13, 2008, at 8:45:54
I have used Seroquel for sleep PRN for about a year. The use has been sporadic over that time. I usually always have to use it when I am trying an anti-depressant. I also have insomnia a lot anyway and sometimes use it on those nights. I am trying of late to not take it though. 25mg just makes me so tired all into the next day even and when the tiredness wears off it is replaced with this awful anxious feeling. I don't know why. The longest I took it consecutively was like three weeks and that was a year ago, when I first started it. I didn't get the anxious feeling when the tiredness wore off back then, but I was on Klonopin at the time so maybe that is why. Now I am on nothing else.
Abilify- too activating. even 2mg acts like an anti-depressant in me. Insomnia, restlessness, can't think... etc....
Risperdal- I have not tried
Geedon - I have not tried
None of those would be of primary help to my OCD though. I have heard of augmenting with them though, especially Risperdal and more recently Abilify.
Posted by crittercuddler on December 13, 2008, at 14:45:05
In reply to Re: Sick newbie w/ bad OCDcan't tolerate an SSRI. HELP » crittercuddler, posted by llurpsienoodle on December 13, 2008, at 8:45:54
Oops I didn't finish.
I have tried to get on Lamictal several times, but I never can make it past 50mg without getting scared because it makes me feel odd. On my last trial it was making it hard for me to remember words and articulate myself on 25mg for 9 days. I was taking it by itself. I was having sporadic sleep on it a well. Some nights I slept good, others it was awful. I was also concerned to just be on Lamictal at 25mg and going up slowly and not an anti-depressant of some sort because I am so unstable. That is another reason I stopped it. The other times I tried Lamictal before that I just remember I would feel something that scared me off of it when I hit 50mg. I never had the word thing before, but I was on Klonopin for all of the other trials, so I don't know.
My psychiatrist's theory is that putting me on a seizure med, like Lamictal, will help calm my nervous system down so I can take an SSRI again. However, I haven't been able to take any I have tried for more than a few weeks because I get so scared of the side effects. Gabapentin made me feel drunk and blank at 300mg twice a day. ( I stuck that one out a few weeks) Trileptal made me feel really odd (tried that one day). And well, I just told you about Lamictal.
My OCD makes taking medications difficult because I obsess so bad over any side effect, especially if it cognitive, with the nature of my OCD fears. Now, I NEED TO CLARIFY that not being able to tolerate an SSRI is not because of my OCD fears. I will admit however that many other meds I could have likely tried for longer than I have. It is a catch 22. Need the meds to help me, but without being stable on a med I can't seem to take a med. It is driving me out of my mind.
Wellbutrin- haven't really tried
Thank you for your suggestions. :-)
Posted by Nadezda on December 15, 2008, at 16:43:23
In reply to Re: Sick newbie w/ bad OCDcan't tolerate an SSRI. HELP, posted by crittercuddler on December 13, 2008, at 14:45:05
Hi, crittercuddler.
Have you talked to your pdoc about trying other ADs? There's wellbutrin, remeron, cymbalta and effexor, and the Maois, among others. These work for different people and sometimes it takes several trials before you find the right one. It sounds like SSRIs aren't the way to go any more.
But I do have to wonder if your reaction to meds isn't to worry a lot more about your mental abilities, etc, and to be prone to judge them more, out of anxiety and perhaps depression, and pessimism over whether the drugs will help. It's sometimes (not always) hard to separate a nocibo effect from a genuine side effect when you're very worried about something bad happening. It may not be possible to overcome this, but it could explain some of the reaction. You could need to wait it out on a drug for at least a period before deciding that you can't think straight. But of course only you know if the effects seem sufficiently grave to justify quitting without a full trial.
I would encourage you, though, to try some other classes of meds, in the hope that these will be more effective for you. And to be ready to tolerate a period of uncertainty. Usually one or another of these drugs does help people-- especially if properly augmented. So I hope you keep on trying.
It's really the only thing you can do-- frustrating as that may be. Psychopharmacology is not yet an exact science, unfortunately. If you trust your pdoc-- and I think a pdoc whom you trust is a very important part of the process-- and give the meds an adequate trial, I think you have a very good chance of finding something that works.
You might check out the medication boards to find other drugs and other people's reactions to them-- and to report side effects when you do try something else.
Hope you find something that works,
Nadezda
Posted by crittercuddler on December 15, 2008, at 22:23:37
In reply to Re: Sick newbie w/ bad OCDcan't tolerate an SSRI. HELP » crittercuddler, posted by Nadezda on December 15, 2008, at 16:43:23
Nadezda,
It is interesting that you mention a "nocebo" effect. Back when I was first diagnosed I had a hard time getting on medication and in my progress notes, which I have copies of, the doctor mentioned that he felt I was having a nocebo effect. Back then, it took me about seven months to finally take an anti-depressant and stay on it. That of course is a drop in the bucket compared to the 3 years that I have been going on this way now.
I definitely feel like something has changed, and I definitely feel like I don't tolerate SSRIs alone... but I do admit that a "nocebo" effect is likely keeping me off of everything else I have tried. I am very deep in my obsessions and I just can't seem to get out from under them. It is a very catch 22 situation where I need the anti-obsessional properties of a med in order to GET ON a med. Which of course, can't happen.
I always tell myself I am going to stick it out, I try to talk positive to myself, but I always end up compulsively stopping the medication.
ERP guidelines would say that I need to indulge the thoughts of the medicine hurting me and accept that it very well might be and not engage in any compulsion. Do you know about ERP?
Maybe if I go back to my OCD therapist and work on doing ERP for my medication issues. Before, I was doing ERP, hoping that doing the ERP for other obsessions would spill over into helping me with getting on a medicine. It obviously didn't work so maybe I need to just focus on that.
I am leery though... I have a lot of obsessions about failure that play into all of this. I am just sure I won't be able to do it.
=o(
This is the end of the thread.
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