Posted by yxibow on December 3, 2006, at 5:58:02
In reply to OCD help, posted by Kimbersaur on December 3, 2006, at 1:42:20
> Hi guys, I was hoping that I could get some medication advice. I'll try to keep it short.
>
> I am currently on 50mg Seroquel and 250mg Lamictal for OCD and Bipolar disorder (although I am REALLY starting to doubt that I'm Bipolar). A year or two ago I was also on Effexor and a lot more Seroquel, but I stopped the Effexor because of sexual side-effects and lowered the Seroquel because I was sick of the sedation. My OCD symptoms got somewhat worse, but I've been able to deal with them just fine on this low dose- until a couple of weeks ago. I've started having some really disturbing intrusive thoughts (my OCD was mainly just rituals before), and they are getting worse and worse!
>
> So, I am thinking of trying something new, but I am afraid of having the sexual side-effects come back. I think that SSRI's are a bad idea, because Prozac made me paranoid and Paxil made me manic. What else can I try for OCD that wont give me sexual side-effects? My mom suggested Cymbalta (she's a doctor) but I am afraid it will make me anorgasmic or manic or something. Is Anafranil a good option? Abilify maybe?
I was going to suggest Luvox because I felt it really did help OCD and clamped down on intrusive thoughts much better, however you have related that you react differently to SSRIs which may be related to that you have BP or a BP related concomitant, at least to a degree.
Anafranil is sort of a gold standard / dart gun for tough OCD cases. You have you be prepared for the side effects of a tricyclic, which can include possible sedation and sweating from what I recall about Anafranil. It can also cause sexual side effects I think because it is a partial SSRI -- some doctors augment this with a slight amount of Wellbutrin if this is really an issue. However I don't know the dopamine angle here vis-a-vis (possible) BP.
Another choice is an SSRI + a low dose atypical neuroleptic, however since the SSRIs have seemed to make you worse, it would probably be just a low dose neuroleptic. I'm not sure if they have ever combined Anafranil (which is technically just known as an SRI) + a low dose atypical.
Seroquel is the most sedating of all neuroleptics, new and old, this is true.Depending on how you react to neuroleptics, you may or may not find Abilify or Geodon to cause some akathisia (a side effect, not anxiety, but it feels like you want to crawl up the walls -- you can take anticholinergics or beta blockers or benzodiazepines to control this to a degree).
Some people react completely the opposite and find especially Geodon somewhat sedating.
-- Jay
poster:yxibow
thread:709854
URL: http://www.dr-bob.org/babble/20061129/msgs/709856.html