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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by medievil on December 24, 2006, at 9:46:08
my OCD is out of control, and i need some relief now! i was wondering about ultram and benzo's for ocd, or any other meds that kill off ocd right away, only temp untill parnate starts working thx!
any experiences?
Posted by Crazy Horse on December 24, 2006, at 10:08:26
In reply to ocd out of control, will ultram or a benzo help, posted by medievil on December 24, 2006, at 9:46:08
Benzo's should/can help a lot while waiting for an AD to kick in. Klonopin, Zanax and Ativan are good choices.
-Monte
Posted by medievil on December 24, 2006, at 10:45:50
In reply to Re: ocd out of control, will ultram or a benzo help, posted by Crazy Horse on December 24, 2006, at 10:08:26
methadone is very cheap, i was thinking of using it once a week?
morphine seems to work once a week for OCD, dont wonna take more dont wonna get addicted
Posted by Quintal on December 24, 2006, at 12:03:02
In reply to ocd out of control, will ultram or a benzo help, posted by medievil on December 24, 2006, at 9:46:08
Tramadol might help OCD with its opiate and SSNRI action but obviously you couldn't take it with Parnate. The same goes for other opiates - though I remember reading that some opiates have been combined with MAOIs successfully you should really be in hospital to have that treatment.
I remember reading some studies that claimed benzos had no effect on OCD, but I don't know whether that's true in practise.
Q
Posted by medievil on December 24, 2006, at 12:34:22
In reply to Re: ocd out of control, will ultram or a benzo help » medievil, posted by Quintal on December 24, 2006, at 12:03:02
why shouldnt i combine opiates with a maoi?
Posted by jimmygold70 on December 24, 2006, at 13:39:56
In reply to ocd out of control, will ultram or a benzo help, posted by medievil on December 24, 2006, at 9:46:08
You may try Ativan or Valium or Klonopin in the higher dose range. Response varies individually between the three.
> my OCD is out of control, and i need some relief now! i was wondering about ultram and benzo's for ocd, or any other meds that kill off ocd right away, only temp untill parnate starts working thx!
>
> any experiences?
Posted by Quintal on December 24, 2006, at 15:52:59
In reply to Re: ocd out of control, will ultram or a benzo hel, posted by medievil on December 24, 2006, at 12:34:22
>why shouldnt i combine opiates with a maoi?
Opiates are contrindicated with MAOIs because they can cause hypertensive and hypotensive crises.
__________________________________________________
Drug-Drug Interactionsmorphine and tranylcypromine (major Drug-Drug)
Description:
CONTRAINDICATED: The coadministration of narcotic analgesics and monoamine oxidase inhibitors (MAOIs) may rarely result in hypotension, respiratory depression, or coma. The mechanism is unknown but may be related to additive CNS and respiratory depressant effects. Rare case reports of severe hypotensive reactions have included propoxyphene (with multiple medications), morphine, and methadone, although others have reported the safe use of MAOIs with narcotic analgesics including methadone and morphine.
MANAGEMENT:
Some manufacturers consider the administration of narcotics and MAOIs within 2 weeks of each other to be contraindicated. However, morphine has been safely used in MAOI patients who previously had an adverse reaction with meperidine and is generally suggested as an alternative to meperidine in anesthesia, as long as vital signs are closely monitored. Other recommendations include giving patients small initial test doses of narcotics and monitoring vital signs for adverse reactions.
http://www.drugs.com/xq/cfm/pageID_1150/int_1/list_1/values_drugid%3Dd00884%26drugid%3Dd00308%26/OpText_morphine/dr_%2CParnate%2Cmorphine/qx/index.htm
__________________________________________________Tramadol would almost certainly be a major problem because not only does it have opitae-like action but the additional SSNRI action may cause serotonin syndrome.
Q
Posted by Phillipa on December 25, 2006, at 22:34:18
In reply to Re: ocd out of control, will ultram or a benzo hel » medievil, posted by Quintal on December 24, 2006, at 15:52:59
Luvox or anafranil with a bezo for OCD. Love Phillipa
Posted by yxibow on December 26, 2006, at 1:26:14
In reply to ocd out of control, will ultram or a benzo help, posted by medievil on December 24, 2006, at 9:46:08
> my OCD is out of control, and i need some relief now! i was wondering about ultram and benzo's for ocd, or any other meds that kill off ocd right away, only temp untill parnate starts working thx!
>
> any experiences?If your doctor thinks an MAOI will work, I can't argue with him but its not the first thing on the list that I would go for certainly.
Second, what kind of OCD are we talking about, pure obsessions, pure compulsions, obsessions and compulsions, washing, hoarding, counting, trichotillomania, etc?
I would start off with Luvox personally, it does have more effectiveness than other forms of SSRIs probably partially because of its sedating nature. It has a wide range of dosing and though normally at 300 it can be dosed to 400 and possibly 450.
Beyond Luvox, Anafranil is still a gold standard, especially for tough obsessional thought cases.
Augmentation of clonazepam with any SSRI that is not sedating is probably a good thing -- clonazepam may be needed initially on its own regards before an SSRI or a TCA/SRI such as Anafranil starts to kick in.
If those are exhausted I might possibly look towards MAOIs but I would look to augment Luvox and possibly Anafranil (not sure how much its done there) with an antipsychotic, probably a low dose of Seroquel or Zyprexa -- Geodon and Abilify would probably be too activating due to akathisia but you might not be susceptible -- some people are more so. If you have tics, the old line drug Orap is sometimes used although cautiously.
I'm not quite sure why diving straight into an MAOI is being done for OCD unless there's more to the message and you've been through all of the above and then some. Its a serious type of medication and as noted above, opiates and all sorts of things can react with it, and having already OCD on board unless you're not obsessing about medications, which some do, I personally wouldn't go for an MAOI, but that, again, is up to you and your doctor since you've already stated the answer to your own question basically that you are going to take an MAOI. (And by the way, you have to wait 14 days to flush out any of the drugs I mentioned before an MAOI anyhow. It just seems overkill unless your YBOCS is 40, you have never responded to CBT (behavioural therapy), you have never been checked into a hospital where they can monitor CBT, etc. The severity of the problem hasn't really been mentioned, so its hard to respond other than sympathize.
And the trend towards the notion of opiates to "solve" psychiatric disorders is an old line ideology -- I don't know why it is even in discussion with OCD. I know its a painful disorder, I had a breakout of it all through puberty to high school where it was worst. But hospitalization and eventually an SSRI actually after I was mostly "well" was the course. But you can't "drown" the pain of OCD any more than drinking it away -- not to mention that these experiments on here with opiates just sound like a demand of a doctor for a morphine drip. Psychiatrists can lose their licenses over these things, but I've said my piece on it. Sure, I'd love it if oxycontin took away my anxiety disorder but I don't see that happening any more than a fistful of ibuprofen. Just my opinion anyhow.I hope you are having the best of a holiday season
-- tidings
Jay
Posted by medievil on December 26, 2006, at 2:24:54
In reply to Re: ocd out of control, will ultram or a benzo hel » medievil, posted by yxibow on December 26, 2006, at 1:26:14
the reasen for me to pick a maoi is because i also have social anxiety disorder, maoi's are the best for that
i dont mind the diet restrictionshmm anafranil is loaded with side effects :(
my OCD is pure obsessions, about my food, training, sport, medication etc...
Posted by rovers95 on December 27, 2006, at 10:05:40
In reply to ocd out of control, will ultram or a benzo help, posted by medievil on December 24, 2006, at 9:46:08
> my OCD is out of control, and i need some relief now! i was wondering about ultram and benzo's for ocd, or any other meds that kill off ocd right away, only temp untill parnate starts working thx!
>
> any experiences?Hows about memantine??? Im taking it at the moment and i can really see why it would work for OCD........has dramatically calmed me!! i read a few posts in the archives suggesting it was good for ocd!
mark
Posted by Phillipa on December 27, 2006, at 17:27:33
In reply to Re: ocd out of control, will ultram or a benzo hel, posted by rovers95 on December 27, 2006, at 10:05:40
Is that available in the US? Love Phillipa
Posted by Phillipa on December 27, 2006, at 17:29:55
In reply to Re: ocd out of control, will ultram or a benzo help » medievil, posted by Quintal on December 24, 2006, at 12:03:02
Quintal if you are calm you tend to not be so repetitive as I have some OCD as well. Love Phillipa
Posted by Quintal on December 27, 2006, at 21:27:37
In reply to Re: ocd out of control, will ultram or a benzo help » Quintal, posted by Phillipa on December 27, 2006, at 17:29:55
> Quintal if you are calm you tend to not be so repetitive as I have some OCD as well. Love Phillipa
I know in theory that's true - that's why I was surprised that benzos are not usually effective for OCD. I found some of my compulsions got worse on benzos - I could stand by the sink pouring glass after glass of water down the plug hole for hours and not worry what anyone thought about me. The same with amphetamines but with jitteriness.
Actually benzos can make OCD worse and it can appear for the first time in people taking benzos and during withdrawal. This was one of the objections to benzos raised by my ex psychiatric nurse - he'd seen people develop OCD when they'd withdrawn from benzos and they were left with more problems than they started with.
Q
Posted by Phillipa on December 27, 2006, at 21:38:46
In reply to Re: ocd out of control, will ultram or a benzo help » Phillipa, posted by Quintal on December 27, 2006, at 21:27:37
Quintal here's the old but. When a benzo calms me down I don't feel the compulsions to do those things. If feeling anxious and out of control I must do things the same way or drink the same amount of water. Strange. Love Phillipa
Posted by Quintal on December 27, 2006, at 22:24:40
In reply to Re: ocd out of control, will ultram or a benzo help » Quintal, posted by Phillipa on December 27, 2006, at 21:38:46
Phillipa, did you have these problems before you started taking benzos or have they got worse? I only ask because it's possible that you are using the compulsions to deal with breakthrough anxiety - a sort of mini benzo withdrawal syndrome between doses now that you've developed tolerance.
Q
Posted by Phillipa on December 27, 2006, at 23:05:08
In reply to Re: ocd out of control, will ultram or a benzo help » Phillipa, posted by Quintal on December 27, 2006, at 22:24:40
Actually it's better now. My old pdoc had me on let's see xanax, klonopin and chloral hydrate. So really I'm on a lot less now. And the valium lasts longer. But I think depression is worse since I'm unable to get out. Love Phillipa
Posted by tom_traubert on December 27, 2006, at 23:19:50
In reply to ocd out of control, will ultram or a benzo help, posted by medievil on December 24, 2006, at 9:46:08
Obsessional Ocd is such a beast to deal with since all you have is the thoughts, no tangible, quantifiable compulsive behaviors to correct. I'm really sorry you have to go through this right now. You're right, Anafranil does have a load of side effects, but it is effective. I was on a dose of Anafranil and Klonopin for 6 years. I know a lot of people don't like the idea of a benzo, but right now all I'm taking is low level dosage of klonopin, no AD, and things are ok, thanks mostly to CBT. OCD is an anxiety disorder, and the symptoms of obsessional ocd increase as anxiety increase which then cycles until you're in panic etc etc. The point is, the less anxiety, the less obsessional thinking. That's how it works with me, anyway.
There's actually a really good book, the only one of its kind to my knowledge, called "The Imp of the Mind" that deals exclusively with obsessional ocd.
Hope this helps,
tt
p.s. feel free to write back if you'd like to correspond via email about obsessional ocd in general, if you feel that it might be helpful
Posted by rovers95 on December 28, 2006, at 3:53:43
In reply to Re: ocd out of control, will ultram or a benzo hel » rovers95, posted by Phillipa on December 27, 2006, at 17:27:33
> Is that available in the US? Love Phillipa
Yeah it is marketed as namenda, its quite expensive but not stupidly so - and if your pdoc wont approve it you could jus trial it online as it has a low s/e profile and is neuroprotective anyway.
Basically, it is an NMDA antagonist and blocks the actions of Glutamate (the excitory neurotransmitter) allowing GABA to work more effectively. Unfortunately its binding affinity isn't as strong as ketamine so it doesnt increase dopamine or downregulate the HPA axis.
I could therefore see why it failed the trials for depression (although many pdocs have success with it - and it shows antidepresiive properties in the rat!) but am sure it would be good for anxiety and some bi-polar disorders.
There is increasing evidence that some types of OCD, like some types of other affective disorders seems to be influenced by glutamate excess.........and a lot of med research seems to be heading this way!! If you can afford and your pdoc would allow i would give riluzole a blast as its going great guns in the trials, and i would expect more soon.
Have u tried l-theanine before???? Did it do anything for you? this could be a minor indicator!!
good luck!!
mark
Posted by medievil on December 28, 2006, at 11:10:28
In reply to Re: memantine - phillipa, posted by rovers95 on December 28, 2006, at 3:53:43
memantine or riluzole look very ineresting yes, but i can't afford them right now
the problem with my OCD is, that i DONT wonna treat it on bad days
my obsessions are crazy, if i do something bad on a monday (stupid things, could be everything my ocd doenst agree with) i'm just so obsessed i will have bad luck that week, and that it isnt a perfect weekii'm also in a bad week right now (i have more bad then good ones) and i dont wonna treat my OCD, because i think its bad for my brain if it fights ocd when its there full force!!
thats why i just want something that works right away!! something to keep ocd away untill parnate kills it
because i know if i start parnate, i would stop taking it after 3 days thinking it aint the right time to take it, and not listening to these toughts makes my ocd unbeareble!!
so right now, i'm trying to get my hands on morphine or other opiates, they are reported to kill ocd right away and only needed once a week (tought thats a good thing to prevent addiction)
i need them temp untill paranate storts working, if it ever doesits horrible if OCD keeps you from your treatment!! it even doenst "allow" me to eat healthy, i gotta do it when i'm in a "perfect day"
so right here having lots of anxiety on a rubbisch junk food diet
my obsessions suck, sometimes i wish i just do rituals...
Posted by Phillipa on December 28, 2006, at 18:04:09
In reply to Re: memantine - phillipa, posted by rovers95 on December 28, 2006, at 3:53:43
Mark I have theanine Serene with relora. Is this the same? Has Gaba, theanine,taurine,and the relora, holy basil leaf extract with magnesium. 200mg of theanine. Haven't used it since a year ago. Can't remember what it did. Is it okay to take with luvox and valium, and xanax? Love Phillipa
Posted by Phillipa on December 28, 2006, at 18:08:51
In reply to Re: memantine - phillipa, posted by medievil on December 28, 2006, at 11:10:28
Oh no you sound like me. If I do something positive and then come home and something bad happens I blame it on doing something good. And fear of meds keeps me from raising mine for depression as cortisone killed my Mother so fear of meds. All except benzos as years ago they worked very well but no more. Love Phillipa
Posted by tom_traubert on December 28, 2006, at 20:14:56
In reply to Re: memantine - phillipa, posted by medievil on December 28, 2006, at 11:10:28
> memantine or riluzole look very ineresting yes, but i can't afford them right now
>
> the problem with my OCD is, that i DONT wonna treat it on bad days
> my obsessions are crazy, if i do something bad on a monday (stupid things, could be everything my ocd doenst agree with) i'm just so obsessed i will have bad luck that week, and that it isnt a perfect week
>
> ii'm also in a bad week right now (i have more bad then good ones) and i dont wonna treat my OCD, because i think its bad for my brain if it fights ocd when its there full force!!
>
> thats why i just want something that works right away!! something to keep ocd away untill parnate kills it
>
> because i know if i start parnate, i would stop taking it after 3 days thinking it aint the right time to take it, and not listening to these toughts makes my ocd unbeareble!!
>
> so right now, i'm trying to get my hands on morphine or other opiates, they are reported to kill ocd right away and only needed once a week (tought thats a good thing to prevent addiction)
> i need them temp untill paranate storts working, if it ever does
>
> its horrible if OCD keeps you from your treatment!! it even doenst "allow" me to eat healthy, i gotta do it when i'm in a "perfect day"
>
> so right here having lots of anxiety on a rubbisch junk food diet
> my obsessions suck, sometimes i wish i just do rituals...Sounds like a really bad week--hope things turn around soon!! I'd just like to say that recklessly seeking out opiates/morphine is potentially "bad for your brain", treating ocd with a plan is not. It is precisely when the obsessive thoughts are in full force that treatment is most warranted. The thoughts will not go away by themselves, just the opposite. The intensity and frequency of the thougts will vary, but as long as they produce significant levels of anxiety they will never fully disappear.
I'm not preaching here, I know exactly what you're describing: some days, it just comes raining down and there's nothing to be done, just call it a day and wait for the clouds to part, I know. And they will, but you are more likely to feel better sooner if you're able to engage in some form of CBT or writing/relaxation exercise in addition to medication. I know you're waiting for Parnate to "kill it" but what any med will do is just lower the volume for awhile. Which is great, don't get me wrong, but I went years without actually engaging the thoughts, challenging the patterns, because it was too scary or uncomfortable, and I relied on the meds to do their job. But the patterns, especially with obsessional ocd, are so damn predictable and ugly, that you really can start to get a focus on what is and isn't ocd, what is and isn't who you are. Only within the last couple of years have I been able to really come to grips with seeing and believing the ocd patterns/anxiety as the fuel, the template. That the content of the thoughts are symptoms, completely arbitrary, just filler for whatever causes anxiety, whatever maintains the ocd pattern. Meaning that the thoughts and moods, the reactions to people, ideas, situations are not unique to those people, ideas, or situations, that it's the ocd and the automatic thought patterns and associations that accompany the ocd thoughts that really are to blame. I don't know if I'm making too much sense. What I'm trying to say is that with therapy and a lot of convincing I've been able to take a lot of the poison out of obsessional ocd thoughts. I know that when the ocd and anxiety is full tilt that it's unbearable, and I'm really sorry you have to deal with it. I just want to say you're not alone and obsessional ocd can be tamed.
It's not lethal, it's not catastrophic, it just feels that way and I know how horrible it is, but it's not who you are. It's just the thoughts and the thoughts really really suck. Please stay strong and work with the prescribed meds as best you can, hopefully without complicating matters with other drugs.
tt
Posted by medievil on December 29, 2006, at 2:14:00
In reply to Re: memantine - phillipa (nm), posted by zero on December 28, 2006, at 23:25:48
thx guys
today is my first day on parnate, i'l make a log
This is the end of the thread.
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