Posted by phidippus on August 30, 2015, at 19:12:42
In reply to Re: Asenapine (Saphris) for OCD » phidippus, posted by MuseMemento on August 30, 2015, at 16:48:38
Sertraline and Fluvoxamine have one thing in common: they both agonize sigma-1 receptors. So, if you respond to Zoloft, you may respond to Luvox. I was deep in intrusive suicidal ideations when I started taking Luvox and they just stopped. I'm surprised you haven't tried Luvox, yet you've taken lithium and nortriptyline, both of which have been shown in studies to be useless in treating OCD.
The first line of treatment of OCD is therapy. If you aren't involved in and practicing good therapeutic techniques, an antidepressant isn't going to be as effective.
OCD is a serotogenic disorder, with some involvement of dopamine and glutamate disfunction. Second line treatment of OCD is a serotogenic agent-you've been through many, but you still have to try Luvox, Viibryd, Brintellix, Trazandone, Cymbalta, Fetzima, Savella.
The key is to achieve a modicum of response from the anidepressant and then add an atypical antipsychotic if you still have intrusive and recurrent thoughts-an atypical antipsychotic will antagonize dopamine receptors (it is hypothesized that dopamine levels are attenuated in the nucleus accumbens in OCD) and antagonize 5ht2a and 5ht2c receptors which are implicated in the genesis of anxiety.
It is further hypothesized that glutamate plays a role in OCD. Several different studies have indeed indicated that those with OCD have higher levels of glutamate in their brains than those without the disorder. While this doesnt necessarily mean that high levels of glutamate cause OCD, studies continue to show there is some type of connection between OCD and glutamate. What does this mean? Studies have shown that adding a glutamate inhibitor to an antidepressant is effective in the treatment of OCD. Other studies have shown that adding a glutamate inhibitor to a atypical antipsychotic and an antidepressant is even more effective. There are several glutamate inhibitors you can add: Keppra, Zonegran, Riluzole, Lyrica, Gabapentin, Lamictal and NAC.
There are other agents that have shown efficacy in treating OCD: Tramadol, Dextroamphetamine, Caffeine, Ondensetron, Pindolol, but all when added to an antidepressant.
Why couldn't you take the sertraline?
Eric
poster:phidippus
thread:1081849
URL: http://www.dr-bob.org/babble/20150806/msgs/1081935.html