Posted by g_g_g_unit on November 7, 2011, at 6:38:10
In reply to Re: a little progress (sort of) » g_g_g_unit, posted by Phidippus on November 5, 2011, at 18:15:45
> > inattentive ADD, OCD and Major Depression.
>
> You have a spectacular chance to treat all three issues with three medications: an SSRI, Dextroamphetamine and an AAP. Treating the ADHD with a dextroamphetamine, Adderal or Vyvanse also helps to treat the OCD-dextroamphetamine has been studied as a treatment for OCD. The mainstay of the treatment of OCD will always be an SSRI or Clomipramine. At 20 mg, your Lexapro is on the low end for treating OCD properly. You really need about 40 mg. Now, because dopamine levels tend to be on the high side for people with OCD, augmenting SSRI treatment with an AAP is a logical step. Zyprexa is a good choice, I used it a while to great effect.Why did you stop taking Zyprexa?
>
> > Two reasons: a) the fact that most meds I've >tried so far have worsened my attention and I >didn't think APs would be any different in that >respect.
>
> Have you trialed drugs long enough to see if cognitive effects might pass within weeks? APs can sap your attention, but it really depends on which ones. Zyprexa helped me to concentrate (remember, we're aiming to reduce the clutter OCD creates), Seroquel made me feel stoned, Abilify helped with my attention. Latuda so far has improved my cognition. Invega dimmed me a bit...Well, I've been on Lexapro for 3+ months now and the attention-difficulties have persisted. I suppose that since attention is already so compromised in ADD, it takes very little to impair it further. You're right, though, that OCD is also a major focus-drainer.
> I guess I'm saying it takes time and trial to get on the right mix of medications.
>
> > b) My depression is primarily characterized by >anhedonia, amotivation, social withdrawal etc. >and (correct me if I'm wrong) I figured APs >would only worsen those symptoms
>
> How much of your OCD is mixed up in all that depression? What a terrible combo, trying to sort out the OCD thoughts from the depressive thinking. The right AP will calm the OCD thoughts and the depressive thinking. With the right balance of SSRI, an AP is not likely to cause worsening of symptoms.I have mainstay obsessive preoccupations which persist whether I'm depressed or not, but I find that while depressed, I become obsessively jealous of the fact that other people aren't mentally ill, which I guess accounts for that overlap you describe ..
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> > while stimulants are reasonably effective, they >ratchet up my anxiety to unmanageable levels.
>
> I had the same problem with stimulants until I discovered Vyvanse. Have you tried it? I experience no anxiety on it.I'm in Australia. The only stimulants available here are Ritalin, Ritalin SR, Concerta, Dexamphetamine IR, Strattera and Reboxetine.
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> Perhaps you'll need some Clonazepam or Lyrica for the anxiety.
>
> >I was under the impression the former two might >render the stimulant reasonably ineffective?
>
> This is not true. Most stimulants work on D1 receptors, where as most APs hit the D2 receptor. Stimulants also tend to alter glutamate levels in the prefrontal cortex, where most executive funtion is rendered. Most SSRIs compliment this action while APs don't touch it or are 5ht2c antagonists, which actually causes a release of dopamine in the prefrontal cortex as well.
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> > My dad was particularly liable to snap at me >and it's left me terrified of dealing with male >authority figures.
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> Do you have a counselor? One who specializes in treating OCD?Yeah I'm currently seeing a therapist who specializes in OCD.
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> > Since I'm currently in psychotherapy with him, >they usually just involve me spontaneously >engaging with him in issues that have arisen >>that week, or elaborating on points from our >last meeting.
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> I'm always calling my doctor to give him updates on how my meds are making me feel. Haha.
>
> > Maybe, but I haven't been feeling terribly >preoccupied with Lexapro.
>
> Why don't you try something else?Hmm, well, to date I've tried:
Prozac - too much anxiety/insomnia/akathisia
Zoloft - too much anxiety/worsened OCD
Luvox - pretty similar to Lexapro
Mirtazapine - dysphoria, severe anxiety
Clomipramine - anxiety/insomnia/weird movement problems
Nardil - helped depression, but caused insomnia .. possibly worth revisitingThere's not much else, other than Pristiq (my psych isn't really a fan of Effexor, other than as a last resort).
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> >But I am overcome by the sense that I'm being >judged, looked down upon, etc. which is fueled >by his bouts of silence.
>
> This is clearly the OCD talking and you know it.
>
You know, I have to thank you for saying that. The past couple of days I've turned your words into a kind of catchphrase because I'm so prone to getting caught up in whether a problem is 'real' or OCD-based, to the point where I sometimes end up deluding myself.
poster:g_g_g_unit
thread:1001616
URL: http://www.dr-bob.org/babble/20111027/msgs/1001811.html