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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by flip-floppy on September 8, 2006, at 0:33:13
Are anti-psychotics by any chance NOT recommended for treating OCD? I have long suspected that I have Pure-O OCD, but anti-psychotics seem to make my condition worse.
Posted by Phillipa on September 8, 2006, at 1:03:04
In reply to Does anti-psychotics help, or worsen, OCD?, posted by flip-floppy on September 8, 2006, at 0:33:13
Luvox and anafranil are good for OCD. Love Phillipa
Posted by yxibow on September 8, 2006, at 1:52:50
In reply to Re: Does anti-psychotics help, or worsen, OCD? » flip-floppy, posted by Phillipa on September 8, 2006, at 1:03:04
> Luvox and anafranil are good for OCD. Love Phillipa
I would second that, and add a comment. Pure obsessional thought OCD is a hard one to conquer. It is hard to do behavioural therapy on something that seems like streams of nonsense in your mind. I have it to a limited extent, its annoying, its not part of my personality, it includes antisocial thoughts, but not much I can do about it. I once had a psychologist who suggested that for pure obsessional thoughts to just think them as a cloud and imagine them floating away. That's about the only behavioural therapy I can recommend. Getting annoyed at them only seems to provoke them more.
As for the antipsychotic end, I don't know which one(s) you have tried/been prescribed. I would say that those that could provoke what seems like anxiety but is actually a side effect (akathisia) would be more likely to seem worse, but that is just a pure hypothetical.Low potency neuroleptics such as Zyprexa and Seroquel are frequently added in small quantities to medications such as Luvox/Paxil/Prozac/etc, (and probably Anafranil too) to make them "work better" and in the case of pure obsessions that probably is a better use of drug therapy alone I would think.
On the other hand, you may just have an idiosyncratic or paradoxical response to your prescribed neuroleptic or neuroleptics in general. There's no guarantees.
-- Jay
Posted by flip-floppy on September 8, 2006, at 3:08:52
In reply to Re: Does anti-psychotics help, or worsen, OCD? » Phillipa, posted by yxibow on September 8, 2006, at 1:52:50
What essentially happens is that the intrusive thoughts don't disappear, but instead slows down. This causes me to obsess over them even more, which makes me feel deeply depressed (and stupid.) It happens with every anti-psychotic, including Zyprexa and Seroquel. The only exception is low-dose amisulpride, which actually enables me to ignore the thoughts (possibly because of an increase in dopamine.) The only other medications that have worked are benzos and amphetamines.
Posted by SLS on September 8, 2006, at 5:48:00
In reply to Re: Does anti-psychotics help, or worsen, OCD? » Phillipa, posted by yxibow on September 8, 2006, at 1:52:50
> Low potency neuroleptics such as Zyprexa and Seroquel are frequently added in small quantities to medications such as Luvox/Paxil/Prozac/etc, (and probably Anafranil too) to make them "work better" and in the case of pure obsessions that probably is a better use of drug therapy alone I would think.
There are quite a few studies reporting the efficacy of Risperdal in treating OCD.
- Scott
Posted by linkadge on September 8, 2006, at 6:45:19
In reply to Re: Does anti-psychotics help, or worsen, OCD?, posted by SLS on September 8, 2006, at 5:48:00
I think its hard to say. Some researchers conclude that the antiobsessional qualities of the SSRI's are dependant upon stimulation of 5-ht2a/c receptors. I think the reason being, is that these receptors activate the parietal lobes which are often hypofunctional in OCD, and dampen the frontal cortex, which is overactive in OCD.
These receptors modulate gabaergic currents in the frontal cortex. 5-ht2a/c stimulation dampens hyperactive prefrontal cortex activity.
There are a few case reports of mescaline a 5-ht2a/c agonist, being of use in treatment resistant OCD.
The point I'm getting to, is that some of the newer antipsychotics block these receptors, and could (at least in theory) block some of the anti OCD properties of the SSRI's. OTOH, these agents also block certain dopamine receptors, which may convey anti-OCD properties.
So it could depend on the patient, but it could go either way.
Linkadge
Posted by SLS on September 8, 2006, at 7:05:07
In reply to Re: Does anti-psychotics help, or worsen, OCD?, posted by linkadge on September 8, 2006, at 6:45:19
> There are a few case reports of mescaline a 5-ht2a/c agonist, being of use in treatment resistant OCD.
This is interesting. Then ritanserin should exacerbate OCD.
> The point I'm getting to, is that some of the newer antipsychotics block these receptors, and could (at least in theory) block some of the anti OCD properties of the SSRI's. OTOH, these agents also block certain dopamine receptors, which may convey anti-OCD properties.
Brilliant! It looks like you hit the target.
> So it could depend on the patient, but it could go either way.
- Scott
Posted by SLS on September 8, 2006, at 7:13:57
In reply to Re: Does anti-psychotics help, or worsen, OCD?, posted by SLS on September 8, 2006, at 7:05:07
> > There are a few case reports of mescaline a 5-ht2a/c agonist, being of use in treatment resistant OCD.
>
> This is interesting. Then ritanserin should exacerbate OCD.I thought this was interesting:
http://www.maps.org/research/psilo/azproto.html
- Scott
Posted by flip-floppy on September 8, 2006, at 7:34:15
In reply to Does anti-psychotics help, or worsen, OCD?, posted by flip-floppy on September 8, 2006, at 0:33:13
Posted by med_empowered on September 8, 2006, at 11:09:04
In reply to Re: Does anti-psychotics help, or worsen, OCD?, posted by SLS on September 8, 2006, at 7:05:07
Neuroleptics are pretty hardcore, so I'd think one would want to avoid them, especially if other meds had already proven more effective.
The Atypicals have been noted to induce social withdrawal and worsen/induce OCD (I think ths happened with high-dose zyprexa). Its probably the serotonin antagonism run amuck, or maybe its the pre-existing OCD+akathisia but...the picture is pretty mixed, and the side-effects can be long-lasting and severe so...I'd personally say avoid the neuroleptics in favor of safer, older, more proven drugs.
Posted by flip-floppy on September 8, 2006, at 12:11:16
In reply to neuroleptics, OCD, posted by med_empowered on September 8, 2006, at 11:09:04
Yes, I will most likely try high-dose Zoloft or Luvox now (and maybe add 25 mg amisulpride, which has zero affinity for 5ht2a/c receptors.)
Posted by ace on September 9, 2006, at 0:33:39
In reply to Does anti-psychotics help, or worsen, OCD?, posted by flip-floppy on September 8, 2006, at 0:33:13
> Are anti-psychotics by any chance NOT recommended for treating OCD? I have long suspected that I have Pure-O OCD, but anti-psychotics seem to make my condition worse.
They can do this! But on the whole, they help enourmously. I have severe OCD with concomitant pychotic ideation (usually of a self-referential nature). Went on Zyprexa- helped greatly. Seroquel now- helps greatly. I am going to change probably to Risperidone.
Antipsychotics with OCD can be strange. For example, a low dose may help greatly, but if you higher the dose it paradoxically may make your OCD worse!!!!!!!!!
I would recommended trying low doses, also the drugs of choice are Clomipramine, Luvox (only SSRI I have time for), and many many combos.
Hang in there!
Ace
Posted by ace on September 9, 2006, at 0:36:41
In reply to Re: Does anti-psychotics help, or worsen, OCD? » Phillipa, posted by yxibow on September 8, 2006, at 1:52:50
For bona-fide biological based OCD i belive psychotherapy of any type has the potential to make OCD worse in a great % of patients. However, the therapy you recommed I can espouse, and see that it has advantages.
Patients almost invariably channel their obsessions into conquering OCD, which aint going to work.
"you can't talk to illness'!
Cheers!
Ace
Posted by linkadge on September 9, 2006, at 7:39:57
In reply to Re: Does anti-psychotics help, or worsen, OCD?, posted by SLS on September 8, 2006, at 7:05:07
Well how about that study!
I had read something very similar just a few weeks back. Though, I don't know how you locate such things so quickly.
Linkadge
Posted by linkadge on September 9, 2006, at 7:42:24
In reply to Re: Does anti-psychotics help, or worsen, OCD?, posted by SLS on September 8, 2006, at 7:13:57
Yeah, that study too is intersting.
Linkadge
Posted by SLS on September 9, 2006, at 8:01:06
In reply to Re: Does anti-psychotics help, or worsen, OCD? » SLS, posted by linkadge on September 9, 2006, at 7:39:57
> Well how about that study!
>
> I had read something very similar just a few weeks back. Though, I don't know how you locate such things so quickly.I just limit my searches to Canadian studies.
;-)
(I hope I haven't insulted people living inside or outside Quebec).
- Scott
Posted by yxibow on September 9, 2006, at 17:43:01
In reply to Re: Does anti-psychotics help, or worsen, OCD? » yxibow, posted by ace on September 9, 2006, at 0:36:41
> For bona-fide biological based OCD i belive psychotherapy of any type has the potential to make OCD worse in a great % of patients. However, the therapy you recommed I can espouse, and see that it has advantages.
>
> Patients almost invariably channel their obsessions into conquering OCD, which aint going to work.
>
> "you can't talk to illness'!
>
> Cheers!
> Ace
This isn't "talk" or psychodynamic therapy I'm referring to. I was diagnosed with the worst of my OCD (which had been there since puberty) towards the end of high school and was hospitalized for 2 and a half months afterwards during which and for several months after, I was supported by an OCD day treatment program. You agree to do behavioural therapy which has nothing to do with psychodynamic therapy, which is useful, but outside of a supporting nature between doctor and patient is not the angle generally for OCD.
Behavioural therapy means you acknowledge that there is a biological (all OCD has a lifetime biological and genetic origin in the caudate nucleus, its just when it is triggered into action that is psychological. Typically this is puberty but can be any traumatic event in someone's life, who has a biological tendency towards OCD) nature to OCD and one starts a treatment program towards conquering the current variety of OCD one has. This may include gradual reduction of handwashing, showering times, gradual reduction of checking doornobs or stoves or reduction in hoarding. The patient is typically rewarded with praise or some incentive, though that isn't necessarily required -- well praise is always due though of course.
The patient understands that the OCD is not their fault but that they can conquer their actions through behavioural therapy. Some OCD is very hard to manage even with behavioural therapy, though even pure obsessions have been monitored to some extent through behavioural therapy, by reduction of allowing one to become anxious by what is going on in their mind and the realization that it is mixed up thought that is not their own nature.
All of this is often done with the help of agents such as SSRIs and possibly benzodiazepines, to take the edge off of things and help reduce the OCD burden, but still allow the patient to continue with a behavioural program.
-- tidingsJay
Posted by notfred on September 9, 2006, at 21:25:22
In reply to Re: Does anti-psychotics help, or worsen, OCD? » yxibow, posted by ace on September 9, 2006, at 0:36:41
"you can't talk to illness'!
But you can learn skills to cope.
Like learning not to see things as either black or white.
Posted by yxibow on September 10, 2006, at 4:19:43
In reply to Re: Does anti-psychotics help, or worsen, OCD?, posted by notfred on September 9, 2006, at 21:25:22
> "you can't talk to illness'!
>
>
> But you can learn skills to cope.
> Like learning not to see things as either black or white.Which is behavioural therapy.... more or less.
When you learn these skills, you can apply it the next time OCD floats into life, because short of a caudatotomy (which would leave one with quite a mess), OCD is there for the long haul. But that doesn't mean that it cannot be overcome again with the same skills. Sometimes it will require medication again, that doesn't mean one is weak -- rather one is seeking help for a bad flareup.
-- tidings
Jay
Posted by Jerry Falwell on September 14, 2006, at 11:59:29
In reply to Re: Does anti-psychotics help, or worsen, OCD? » notfred, posted by yxibow on September 10, 2006, at 4:19:43
So
This is the end of the thread.
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