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Dr. Bob is Robert Hsiung, MD,
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Posted by phidippus on February 13, 2015, at 15:00:52
In reply to Re: What is OCD?, posted by Bill82 on February 13, 2015, at 13:54:12
Weellbutrin?! Doc has no idea what they're doing. Wellbutrin is more likely to worsen anxiety.
Eric
Posted by ed_uk2010 on February 13, 2015, at 16:20:08
In reply to Re: What is OCD? » Bill82, posted by phidippus on February 13, 2015, at 14:56:35
>You are fighting tooth and nail against 'perceiving that idea is good' when in all reality you are never going to really feel like its ok to act out any of your worst thoughts. All your worst thoughts are junk-they aren't real and born of your imagination. The problem is you want to stay anxious about the thoughts because you feel if you aren't anxious about the thoughts you will actually succumb to them which is just not true.
Very well said, IMO. That's a great summary.
The thoughts are just thoughts, they are not reality, and there is no way Bill is going to act out on them. People who actually do act out on bad thoughts do not spend hours having OCD about them!
Once Bill is not anxious about the thoughts, he won't act out on them... they will just eventually go away.
I don't think Wellbutrin would help OCD. I know the doctor mentioned Lamictal, which seemed to produce some emotional numbing before. Although not highly evidence based, I was wondering whether a different AED such as Trileptal might help. I know Bill's doc didn't want to use Lyrica.
Posted by Bill82 on February 13, 2015, at 16:22:35
In reply to Re: What is OCD? » Bill82, posted by phidippus on February 13, 2015, at 15:00:52
Haha yea that's what I've thought, this is the same doctor who said the car thing, I don't think she even knows what ocd is, I am just trying to be respectful, not sure if I would take it if she offered, but then again don't have much to lose haha. And yea I already do perceive them in sarcastic way at times, it's just with these it at times seems I actually like it which scares me ect ect. I don't know maybe in stubborn, but I get what you are saying. I had ocd onset very suddenly, before I had it I used to have intrusive thoughts all the time. Usually when I was anxious they would get worse but i would just chuckle. For example if be on a date and imagine if I just shouted something embaressing, it would just make me chuckle inside and is forget about it. When the ocd onset I was paralyzed with anxiety, and it almost seemed to stick with me in a ptsd like way, so that now after months of obsessivng my mind has changed and I guess "I don't joke around" with my thoughts. I know they are not real, but maybe it seems at some level I lack insight? Or maybe I'm just stubborn, not sure but that's the best way I could describe it. Also eric what are your thoughts on amantadine, as it has shown effect in ocd but and in a rat model was superior to memantine, being more active in the striatum, but it is also positively affects dopamine transmission(not exactly sure how, I think it encourages more to be released and may be an agonist not sure). I think memantine is also a d2agonist but that it's affinity is negligible.
Posted by Bill82 on February 13, 2015, at 16:26:19
In reply to Re: What is OCD?, posted by ed_uk2010 on February 13, 2015, at 16:20:08
Have not heard of trileptal before it seems interesting. I see there's one rat model that shows effectivness. Consumer reports of people on an epilepsy bored who had ocd and couldn't take ssri due to lowered seizure threshold said it didn't seem to alter the ocd all that much, but that dosnt mean it couldn't help me. I'll have to run it by him, the AED are very interesting in how different they all are from one another and how many there are, increases the chance they could help. Thanks for the responses guys
Posted by Bill82 on February 13, 2015, at 16:39:48
In reply to Re: What is OCD? » Bill82, posted by phidippus on February 13, 2015, at 15:00:52
I have 2 p docs at the moment, thought if clarify that. One is a ho hum basic one covered by insurance, the other is a specialist in ocd.
Posted by phidippus on February 14, 2015, at 0:51:29
In reply to Re: What is OCD?, posted by ed_uk2010 on February 13, 2015, at 16:20:08
>Although not highly evidence based, I was wondering whether a different AED such as Trileptal might help. I know Bill's doc didn't want to use Lyrica.
To augment treatment of OCD with an SSRI it is recommended that a anti-glutamatergic agent be added. Some of these agents include Keppra, Riluzole, Zonegran, Lamictal, Lyrica, Neurontin and Topomax. Trileptal would not be suitable because it is not anti-glutamatergic.
Eric
Posted by phidippus on February 14, 2015, at 1:07:32
In reply to Re: What is OCD?, posted by Bill82 on February 13, 2015, at 16:22:35
>it's just with these it at times seems I actually like it which scares me ect ect.
It is not uncommon for patients with OCD suffering pedophilic obsessions sometimes get sensations in their privates which they will mistake for real arousal.
The thought that you 'actually like' the thoughts is part of the OCD. The challenge is to confront those thoughts, agree with them and disregard them as more nonsense. Again you're being scared of being scared of something that's not real.
>my mind has changed and I guess "I don't joke around" with my thoughts.
I implore you to change that policy because humor goes a long way to diffusing fear and anxiety.
>I know they are not real, but maybe it seems at some level I lack insight?
I don't think you lack insight, I just think very wrapped up in feeling afraid.
>What are your thoughts on amantadine?
I've seen one case study which was positive.
I have used it myself and perceived no effect.
Eric
Posted by ed_uk2010 on February 14, 2015, at 9:49:31
In reply to Re: What is OCD? » ed_uk2010, posted by phidippus on February 14, 2015, at 0:51:29
>Some of these agents include Keppra, Riluzole, Zonegran, Lamictal, Lyrica, Neurontin and Topomax. Trileptal would not be suitable because it is not anti-glutamatergic.
According to the studies on PubMed, it seems that all the AEDs which act as Na+ channel blockers, including oxcarbazepine (Trileptal), inhibit the release of glutamate. Carbamazepine (Tegretol), oxcarbazepine, lamotrigine (Lamictal) and phenytoin are among the most potent and widely used Na+ channel blockers, but several other AEDs have this property too. To what extent inhibiting glutamate release is useful in OCD is not well understood, it seems.
Posted by Bill82 on February 14, 2015, at 12:00:40
In reply to Re: What is OCD? » phidippus, posted by ed_uk2010 on February 14, 2015, at 9:49:31
What opinions do you guys have on glyx13. Two things it's being tested for atm in phase 3 is ocd and depression. Lady who is doing ocd study is a little over zealous about ketamine working in ocd in my opinion though, but then again she could be right.
Posted by ed_uk2010 on February 14, 2015, at 18:11:49
In reply to Re: What is OCD?, posted by Bill82 on February 14, 2015, at 12:00:40
> What opinions do you guys have on glyx13. Two things it's being tested for atm in phase 3 is ocd and depression.
I think it's fascinating. It looks very promising for depression. I must admit I have little idea with respect to its anti-OCD potential.
Posted by phidippus on February 16, 2015, at 1:31:13
In reply to Re: What is OCD?, posted by Bill82 on February 14, 2015, at 12:00:40
There's a lot more data on depression and ketamine than there is for ketamine and ocd.
Eric
Posted by Bill82 on February 17, 2015, at 14:15:14
In reply to Re: What is OCD?, posted by phidippus on February 16, 2015, at 1:31:13
Little off topic I guess? But anyways I just learned about PKa and PKc and their involvement in OCD. The article below describes how PKc effects 5ht uptake in ocd vs controls, with evidence supporting 5ht uptake is depressed in ocd, and the PKc agonist in both groups depressed uptake further, although more significantly in OCD subjects. Also other studies have shown PKc to be hyperactive in ocd and PKa to be hypo active. Reading up in the two and their effects in the brain it shows that their effects are primarily on the 5ht system primarily being 5ht2a. Perhaps level of cellular function in a more accurate targeting method could be the future if OCD? Just thought id share because it gave me some hope today, just got an ivig infusion and ocd is aweful/seemingly more real and that I don't care. Anyways let me know if you have any thoughts.
Posted by ed_uk2010 on February 17, 2015, at 18:44:02
In reply to Re: What is OCD?, posted by Bill82 on February 17, 2015, at 14:15:14
Hey, do you have a link to the study you're discussing?
Posted by Bill82 on February 17, 2015, at 19:17:59
In reply to Biology, psychology and OCD » Bill82, posted by ed_uk2010 on February 17, 2015, at 18:44:02
Sorry my memory is trash recently. Here are three studies relating to the basic statement I made.
http://www.ncbi.nlm.nih.gov/m/pubmed/12183213/
Posted by ed_uk2010 on February 17, 2015, at 20:54:47
In reply to Re: Biology, psychology and OCD, posted by Bill82 on February 17, 2015, at 19:17:59
Hi Bill,
Thanks for the link.
I wondering whether the changes in activity of PKC occur in response to changes in synaptic serotonin levels.
I read several things about this:
A. Serotonin reuptake transporters are apparently fewer in number in pts with OCD. This could be the brain's attempt to compensate for a serotonin deficit.
B. Activation of of the enzyme PKC results in a decrease in serotonin reuptake. This may occur due to the serotonin transporters being internalised ie. removed from the neuronal cell membrane.
C. Activation of PKC in untreated OCD may be part of the compensatory mechanism described above. It may occur in response to a serotonin deficit, and could compensate partially for this deficit by reducing the number of active serotonin transporters.
D. Chronic treatments with SSRIs seems to reduce the expression of PKC in OCD. If PKC reduces the number of membrane serotonin transporters, you can see why the activity of PKC might be suppressed by SSRIs. It could be a further compensatory mechanism in order to avoid excessive inhibition of serotonin reuptake.
E. Strangely enough, the opposite, increased SERT availability, has been reports in the brains of untreated OCD pts by other researchers. The areas of the brain involved may have been different.
F. The problem with this type of speculation is that no one, including the scientists involed, appear to understand the immense complexity of neurological function very well!
G. I suppose we can say with some certainty that serotonin neurotransmission is closely linked to OCD symptoms, in some way. Whether this is primary, or secondary to some other abnormality is unknown.
Posted by Bill82 on February 18, 2015, at 0:11:18
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by ed_uk2010 on February 17, 2015, at 20:54:47
Goof points, I just brought this up because as far as I'm aware genetics don't show abnormal sert genes in ocd, so it is an interesting idea of what may be linked to messed up seritonin transmission. Most people also assume it's a problem with neurotransmitters, but this was neat in that it was much different. But I agree the complexity is insane and therapeutically this offers no value as the agents are not medically approved and way to unselective for theraputic use. Also I've been wondering if you guys had any input on life with ocd. At the moment my life is destroyed, and I can't do much except sit or sleep and even then I am under constant stress/pain. If you have had ocd that went away what is it like? And am I right to be slightly saddened I will most likely miss out on my youth?
Posted by phidippus on February 18, 2015, at 17:24:07
In reply to Re: What is OCD?, posted by Bill82 on February 17, 2015, at 14:15:14
Though it suggests potential new therapeutic targets in OCD, I still have a feeling any drug therapies derived from the findings would be augmentations.
Have you ever tried Keppra?
Eric
Posted by phidippus on February 18, 2015, at 17:35:07
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 18, 2015, at 0:11:18
>At the moment my life is destroyed, and I can't do much except sit or sleep and even then I am under constant stress/pain.
You're the first person I've met impaired by their imagination.
>If you have had ocd that went away what is it like?
I used to think about killing myself day in and day out. I started taking fluvoxomine and one day the thoughts just stopped.
>am I right to be slightly saddened I will most likely miss out on my youth?
If you stay in the house your youth will be a sad one, indeed.
Eric
Posted by Bill82 on February 18, 2015, at 18:36:49
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by phidippus on February 18, 2015, at 17:35:07
If you don't mind me asking,
How is you sexual functioning on fluvoxamine?How is your mental functioning in terms of cognition memory and general reasoning on fluvoxamine?
How is your general energy/weight gain on it?
What dose and what other meds were you on when it started to work?
Posted by Bill82 on February 18, 2015, at 23:34:31
In reply to Re: What is OCD? » Bill82, posted by phidippus on February 18, 2015, at 17:24:07
No have not heard much about it except for keppra rage, but pretty sure that's just an exaggeration.
Posted by phidippus on February 20, 2015, at 15:06:06
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 18, 2015, at 18:36:49
My sexual functioning is unaffected by the Fluvoxamine.
Fluvoxamine does not affect my cognition, memory or ability to reason. If anything my memory is improved-and since I'm not overwhelmed by obsessions, I would say my cognition is better as well.
I've had no loss of energy while on Fluvoxamine and no weight gain either.
I was on 900 mg of Lithium,240 mg of Geodon, 70 mg of Vyvanse and 100 mg of Fluvoxamine when my OCD just disappeared.
Eric
call me anytime you want btw - 720-273-7293
Posted by SLS on February 21, 2015, at 7:37:53
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by phidippus on February 20, 2015, at 15:06:06
> My sexual functioning is unaffected by the Fluvoxamine.
>
> Fluvoxamine does not affect my cognition, memory or ability to reason. If anything my memory is improved-and since I'm not overwhelmed by obsessions, I would say my cognition is better as well.
>
> I've had no loss of energy while on Fluvoxamine and no weight gain either.
>
> I was on 900 mg of Lithium,240 mg of Geodon, 70 mg of Vyvanse and 100 mg of Fluvoxamine when my OCD just disappeared.Gosh! That's terrific!
- Scott
Posted by Bill82 on February 24, 2015, at 13:37:53
In reply to Re: Neurobiology of OCD - speculation, posted by SLS on February 21, 2015, at 7:37:53
Got my genetic testing back some interesting stuff. Was prescribed lamotragine so we will see how that goes. Worried about memory or libido problems but have told myself I will just white knuckle it until he says to stop, unless of course I have serious side effects such as steven johnson rash or other allergic reactions. Anyways check out the results and if you have any hhoughts post them I'd love to hear.
SLC6A4- result-L(A)/L(G)
Serotonin Transporter-patient exhibits a mutation of the serotonin transporter associated with reduced reuptake of seritonin, less satisfactory response to ssri, and a potentially greater risk for adverse effects from ssri. This variant has also been associated in literature with lower stress resilience and higher rates of PTSD.
5ht2c -Serotonin Receptor result- C/C
Serotonin has potent satiety signaling activity and 5ht2c antagonism has been shown to lead to increased food intake. This patient exhibits a variant of the 5ht2c receptor which has been associated with satiety in the hypothalamus.
CACNA1C Calcium Channel-result G/A
The patient exhibits a variant in the gene coding for a subunit L-type voltage gated calcium channel. Days regulation of this channel has been associated with changes in neuronal depolarization, amygdala volume in schizophrenics and bipolar patients, frontal hippocampus connectivity, disruptions in cognition in both schizophrenic and bipolar patients, and has been hypothesized to be related to glutamate signaling. Clinically has been associated with conditions charecteriEd by mood instability or lability.
Mtfhr-impared folic acid metabolism and blunted activation in the anterior cingulate.
CYP2D6 - cytochrome P450 2D6- result - intermediate metabolizer
Reduced hepatic degradation and higher plasma levels of flouxetine fluvoxamine paroxatine sertraline duloxetine venlafaxine mirtazipine nefazadone apriprazole haloperidol iloperidone risperidone atomoxetine amphetamine-dextrothetamine methamphetamine olanzapine codeine methadone tramadol vortioxetine TCA's phenothiazines
CPY2C19 Cytochrome p450 2C19- result - ultra rapid metabolizer
Poorer efficiency and reduced plasma levels of citalopram escitalopram diazepam clomipramine imipramine trimipramine
Posted by phidippus on February 24, 2015, at 15:36:53
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 24, 2015, at 13:37:53
>Was prescribed lamotragine so we will see how that goes. Worried about memory or libido problems
Lamictal may affect your memory, however I doubt it will affect your libido.
Explain to me why you are afraid drugs will affect your libido.
>reduced reuptake of seritonin, less satisfactory response to ssri, and a potentially greater risk for adverse effects from ssri.
this explains a lot and all around sucks.
Have you ever been on Mirtazapine?
Eric
Posted by Bill82 on February 24, 2015, at 15:54:53
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by phidippus on February 24, 2015, at 15:36:53
I don't really know to be honest, one of my first obbsessions was that a girl I was talking to and really liked/got along with was starting to get closer to me, and as I was a virgin at the time I was worried of becoming either impotent or uninterested in here in the future and then losing her. Weird as hell but it's just an older obsession I guess so I worry about it. Do you say lamictal May effect memory from personal experience or from studies. My memory is already partly messed up so for it to get worse would suck, but if it helps I'm willing to try it. I wonder if the biaxin or minocycline could be behind some of my current memory issues.
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