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Re: Must I stop my beloved Nardil????? ace

Posted by SLS on April 16, 2004, at 11:36:56

In reply to Re: Must I stop my beloved Nardil????? SLS, posted by ace on April 16, 2004, at 1:30:03

Hi Ace.

> > By the way, what exactly are your symptoms of OCD?

> Scott, my symptoms are atypical and refractory at the moment.

I wish I were better informed about OCD. However, in light of the atypicality of your symptoms and your many failures to treat them, I guess the logical question to ask is how confident are you that it is indeed OCD that you are treating?

Do you perform any rituals repeatedly?

> 1. an idea comes into my head that it will be 'bad' if i do this or that. then this thought comes and says 'yes' to the bad thought. But i have to 'protect' myself from the 'bad' thought and say 'no' over it before the 'yes' gets in.

I can see how this would be ritualistic. Is there anxiety? More specifically, do you experience an anxiety that can only be relieved by saying "no" repeatedly a certain number of times? How do you compare what you experience from non-OCD intrusive thoughts.

> 2. All symptoms are ego-dystonic and painful.

I can see that you are thoroughly read on this topic.

Just curious - do you meet the criteria of the DSM diagnosis of OCD?

> 2. I can ruminate on past 'bad' thoughts which have 'come through' and been said 'yes' too. Like if i write a essay a thought will come and try and defile this essay. If the bad thought gets said 'yes' too, i then have very strong negative, stifling, and painful sensations to do with this essay. it hurts and stifles any feeling of growth accomplashment, etc.

That must be tormenting.

> 3. More 'normal' OCD- hoarding, checking, etc

I see.

> 4. I have OCPD too.

What's that? I guess I'll go Googling. Be right back...

Hmmm. I see. I can see where the hoarding fits in. I've never heard you speak of perfectionism or the need to be meticulously organized, though. However, I think one could argue that an OPCD need to have things be perfect could drive you to find the perfect drug combination for the attainment of the perfect conscious experience. I should stop here before I start analyzing you. lol ;-)

> Tell me what you think Scott. I respect you bro.

To be honest with you, I don't know you well enough to make any judgment regarding your condition or its treatment. The differential diagnosis between OCD and OPCD can be difficult. OPCD doesn't seem to be as well understood as OCD, and its treatment is still being debated. I guess someone once tried to shove CBT down you throat. However, I can imagine how some type of psychotherapy might be advantageous for some people to help them break looping cognitive cycling. Perhaps looking at the specific content of the patterned thoughts and behaviors would provide a tool to recognize and diffuse the cycles. I find myself rambling as I attempt to brainstorm your situation. I apologize. I wonder if the reason why high-dose SSRI therapy is sometimes effective for OCPD is that it simply produces apathy and passivity such that the driving force is neutralized enough to reduce the energy available to facilitate the perfectionism and ritualism. I would hope that it be more targeted towards the initiation of the obsessive content rather than to simply facilitate its dilution downstream. I get the impression that discriminating the differences between OCD and OPCD, that is to say, establishing a differential diagnosis, might be important at some point. I think you should look closely to see whether or not you can exclude OCD, as it doesn't seem necessary that it and OPCD be comorbid.

> Do you think Zyprexa 10mg is worth a shot?

Of course. You've tried so many things already, you can't afford to leave any stone unturned. I get the feeling that 5-10mg is the sweet spot for the application or Zyprexa in non-psychotic and non-delusional conditions.

There has got to be something out there for you. Keep trying. I offer the possibility that you have OCPD without OCD, in which case using serotonin reuptake inhibitors might be barking up the wrong tree. This is something short of a completely wild guess, though.

You did ask. :-)

I simply don't know enough.

You'll get there. Just keep an open mind. I am very glad that you have found Nardil. You have a wonderfully creative mind, and I think your persistence will pay off.

:-)

Peace be with you...


Sincerely,
Scott

 

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