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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by BRC on June 16, 2008, at 18:23:43
Hi,
I haven't posted here in a long time. So, first I would like to tell everyone hello.
I have really bad OCD. I have tried all the meds, but nothing really has helped.
The reason I am asking is my long time p-doc is retiring this month and I will be seeing a new p-doc on my next visit.
I have been on my regimine of meds for so long that I am afraid to mess with them, but the OCD isn't getting any better and I figure maybe a new doc will have a better alternative.
I currently take cymbalta 60mg, Luvox 200mg, Klonopin 4mg, Remeron 30mg, Lyrica 300mg. All of the meds are not just for OCD. Some are for anxiety, depression, etc. And the meds work well for those ailments. That is why I am so hesitant to speak out about a change.
It is just the OCD that is so bad. Especially the intrusive thoughts.
I was just posting to get other's input on the situation.
Thanks,
BRC
Posted by Phillipa on June 16, 2008, at 19:02:25
In reply to For OCD sufferers what meds have helped you., posted by BRC on June 16, 2008, at 18:23:43
Well Luvox worked for me at least for OCD not depression or anxiety. Anafranil is a TCA Supposed to be good for it. More side effects though. Good luck with new pdoc. Phillipa
Posted by BRC on June 16, 2008, at 19:49:02
In reply to Re: For OCD sufferers what meds have helped you. » BRC, posted by Phillipa on June 16, 2008, at 19:02:25
Thanks for the response. I was on Anafranil for a pretty good while with little or no help.
Luvox is definitly better than Anafranil when it comes to side effects.
BRC
Posted by Phillipa on June 16, 2008, at 20:24:29
In reply to Re: For OCD sufferers what meds have helped you. » Phillipa, posted by BRC on June 16, 2008, at 19:49:02
Seriously no idea of what to suggest maybe theraphy? Love Phillipa
Posted by yxibow on June 17, 2008, at 5:06:12
In reply to For OCD sufferers what meds have helped you., posted by BRC on June 16, 2008, at 18:23:43
> Hi,
>
> I haven't posted here in a long time. So, first I would like to tell everyone hello.
>
> I have really bad OCD. I have tried all the meds, but nothing really has helped.
>
> The reason I am asking is my long time p-doc is retiring this month and I will be seeing a new p-doc on my next visit.
>
> I have been on my regimine of meds for so long that I am afraid to mess with them, but the OCD isn't getting any better and I figure maybe a new doc will have a better alternative.
>
> I currently take cymbalta 60mg, Luvox 200mg, Klonopin 4mg, Remeron 30mg, Lyrica 300mg. All of the meds are not just for OCD. Some are for anxiety, depression, etc. And the meds work well for those ailments. That is why I am so hesitant to speak out about a change.
>
> It is just the OCD that is so bad. Especially the intrusive thoughts.
>
> I was just posting to get other's input on the situation.
>
> Thanks,
>
> BRCWhat form of OCD is it specifically -- is it only intrusive thoughts, or are there other aspects of it? Intrusive thoughts usually mean the repetitive unwanted thoughts of a specific thing over ad nauseum.
I currently suffer from an unknown amount of OCD, panic/anxiety, symptomatic forms of somatiform disorder and depression.
I can certainly understand unwanted OCD as I was in hospital younger for washing for reasons I won't go into for my privacy but my Y-BOCS was something like 36-39.
At any rate, that is a lot of serotonergic agents going on there so your psychiatrist, hopefully psychopharmacologist has to maneuver things around very carefully to prevent serotonin syndrome.
I can't tell you what will be most effective for you -- if you are someone with OCD who responds negatively to NE (norepinephrine) which raises adrenaline then in the long run Cymbalta may not be the best thing (even though theoretically the serotonin is 6:1 NE)
But I reread that about anxiety and depression.I think a new doctor, if not for anything else but medicine consultation is a good thing. But don't go in expecting a miraculous list of undiscovered drugs -- I got a second opinion, again for privacy I won't go into it -- the point was positive, but I was expecting that someone, someone out there, including this community had a disorder like my own.
So take second opinions with the knowledge that another doctor may have used different medications in his/her practice and may have a different strategy, but there are only so many medications out there and some which they may try to list, may interact with whatever you have been doing or trying.
If you didn't have so many serotonergic agents (Cymbalta, Remeron at the cusp of serotonin level, and Luvox) I would suggest consolidating all the serotonergic agents into a much higher dosage of Luvox, typically it can be dosed to 400-450mg, depending on the metabolism of the patient. Electric shocks may be a side effect, at least I had them, when exercising, just because of the level of agent. But that's an individual case.I think Luvox is actually an excellent agent for OCD as it was coined for, marketing, or reality -- it is more sedating than Prozac, which may hyperactuate things, although it was among the first used for OCD, and it doesn't suffer from missed dosage problems of the other sedating medication, Paxil.
There are also CBT methods -- and I know it is -Extremely- hard with intrusive thoughts, but there are some, for battling OCD. It is a lifelong biochemical condition triggered at some age, typically first onset around puberty to teenage, but could be earlier or later due to some psychological reason.But there is hope. Much research that I am intimately aware of (scanning) has been done since I had my first episode and I did attend a treatment program at a certain institution that helped follow up things.
Now, I'm battling something I've never seen before and agents have to be moved around very carefully, but I still understand intrusive thoughts, because I have random "full head" depending how anxious I am, which is basically still the OCD running along making random words and things I see or hear or have thought about in the past or just don't make particular sense.
Focusing on them of course makes it worse, yet letting it stream by and say "who cares" also is distracting from what I need to do because it still comes to the forefront.
So to sum up a long note -- its not all medication, its an art and a science, and some of it may be rehabilitation work and CBT and some people with OCD tend to work better with structure, not straying away from things, which I admit I do -- like typing here now :) Okay, I had to put some humour into what I know is a really bad situation (for all of us here, I'm sure we can relate on some level).
-- best wishesJay
Posted by BRC on June 17, 2008, at 7:31:54
In reply to Re: For OCD sufferers what meds have helped you. » BRC, posted by yxibow on June 17, 2008, at 5:06:12
Thanks for taking the time to give such a detailed post.
I think I know what the Y-BOCS (sorry if I mispelled). It is the initials of the test used to measure your level of OCD. I don't remember what mine was.
I too was hospitalized years ago for my OCD, anxiety, and depression. My OCD does not manifest in any way about contamination and germs. It is mainly intrusive (which in my case are horrible thoughts), having to have things arranged in order, and doing even ordinary tasks a specific way.
I am sorry to hear about your OCD problems and really wish you the best.
I have also been researching and I have come across some reports of where SSRI's have been augmented with low doses of the newer forms of anti-psychotics to treat the intrusive thoughts of OCD. But I am weary of the side effects of anti-psycotic medication.
Again, wish you the best with your OCD woes and thanks for your response.
Please forgive my spelling :).
BRC
Posted by blueboy on June 17, 2008, at 9:52:49
In reply to For OCD sufferers what meds have helped you., posted by BRC on June 16, 2008, at 18:23:43
I hate to say this, but I have never noticed any drug helping with my OCD. It is mild in my case compared to depression, anxiety, and mania. I did the Y-BOCS and got a "moderate" score but, subjectively, I would call it "mild".
So, I'll follow this thread with interest. It's a very difficult disease to treat.
Posted by sunnydays on June 17, 2008, at 11:21:54
In reply to For OCD sufferers what meds have helped you., posted by BRC on June 16, 2008, at 18:23:43
I just admitted to my 'rituals', so we're justing starting to treat. Right now, since I was already on Effexor, we've raised it to 225mg/day, and I was also on 50mg Lamictal, but I hope to nix that soon when it won't mess up other med changes because it's not doing anything. Also, am taking 1mg Xanax at night for a week to help me sleep because my rituals interfere with me getting to sleep... only problem is, I am finding I can't let myself take it until after the rituals are over, so it's not doing what it's supposed to for the most part.
sunnydays
Posted by SLS on June 17, 2008, at 12:22:13
In reply to Re: For OCD sufferers what meds have helped you., posted by sunnydays on June 17, 2008, at 11:21:54
Hi.
Check out the use of memantine (Namenda) in OCD.
- Scott
Posted by nellie7 on June 17, 2008, at 14:03:04
In reply to For OCD sufferers what meds have helped you., posted by BRC on June 16, 2008, at 18:23:43
Hi,I also suffer from severe OCD - mainly intrusive thoughts. I take Celexa which helps slow down the racing thoughts and have been advised (putting it mildly :)) to take low dose antipsychotics as well. Like you, I am concerned about their side effects and cannot tolerate them anyway.
Maybe you can give Celexa or Lexapro a try, if you haven't already. I used to take Luvox and found it more stimulating than Celexa.
I hope you find something that works.Take care,
Nellie.
Posted by BRC on June 17, 2008, at 18:28:50
In reply to Re: For OCD sufferers what meds have helped you. » BRC, posted by nellie7 on June 17, 2008, at 14:03:04
I took both Celexa and Lexapro for my OCD. I maxed Lexapro way out. My p-doc had me on a pretty high dose. B/C as we OCD suffer's know it takes a higher dose and longer time to find relief from SSRI's to treat OCD.
I wish you the best.
BRC
Posted by BRC on June 17, 2008, at 18:37:35
In reply to Re: For OCD sufferers what meds have helped you., posted by blueboy on June 17, 2008, at 9:52:49
I think you are right I have tried everything (or at least I like to think :) the docs had to offer in the way of medication.
I even have tried all the nutritional and supplements, but no luck.
I think the about the only way to get a moderate to severe case of OCD under control is with the right meds and a lot of CBT therapy. But who has the time for all of that?
My retiring p-doc who is suppossed to be the best in the area I live in (they even named a hospital after him) told me point blank that you can expect to see about a 70% reduction in OCD with meds and that is if your doing good.
Best of luck.
BRC
Posted by yxibow on June 19, 2008, at 5:06:18
In reply to Re: For OCD sufferers what meds have helped you. » blueboy, posted by BRC on June 17, 2008, at 18:37:35
> I think you are right I have tried everything (or at least I like to think :) the docs had to offer in the way of medication.
>
> I even have tried all the nutritional and supplements, but no luck.
>
> I think the about the only way to get a moderate to severe case of OCD under control is with the right meds and a lot of CBT therapy. But who has the time for all of that?Its true -- its hard to find time in life to do all the things that you need in a day, or weekly chores. But there is no one single pill that will eliminate OCD.
It is, for almost all people, a "hardwired" biochemical circuitry, you could say. That is why devoting some time, and I know it is hard to find it, to CBT.
It has been shown since the early 90s, that yes, that double blind PET studies with controls, taking an SSRI is as good as CBT.But there comes with an additional note -- taking an SSRI or other medication for OCD and doing some sort of CBT, even a small amount, is even better.
And finally, and I'm not saying this is your case, around 99% of OCD cases are within the OC Spectrum. But some fraction of cases come close to having a psychosis element to it -- that word is so charged for some people that I hesitate to use it -- because it isn't what one normally thinks of "psychotic".
> My retiring p-doc who is suppossed to be the best in the area I live in (they even named a hospital after him) told me point blank that you can expect to see about a 70% reduction in OCD with meds and that is if your doing good.
There is no guarantee of how much reduction in OCD -- it is subjective. Even the Y-BOCS, which is scored objectively (number amounts or yes/no for each question), is subjective from the patient (how intrusive is intrusive will naturally vary). Some wiggle room for this is built into tests, of course.And yes "if you're doing good...." As noted before, OCD is a lifelong (I don't mean a life sentence -- that is what is so important about trying CBT because it teaches tools and tricks to focus, move forward, and letting go, among other things) condition.
I would say for uncomplicated cases, and that's completely subjective as well, maybe 70%, maybe only 30%... but you can't expect to just take, e.g. Paxil and not have OCD. It just doesn't work that way. The "noise level" may go down.
Also often while SSRIs are being used initially, benzodiazepines (often Klonopin) are used short term if there is an anxiety adjustment side effect that needs to be worked out.
As for a previous posting of Atypical Antipsychotics (Neuroleptics) + SSRIs, yes -- these are used for management of difficult (or true OCD with psychotic features --- as noted, this is somewhat to considerably less than 1% of OCD cases) cases of OCD.
Typically a low dose (maybe 100mg of Seroquel, say) -- and just from my opinion, if you are hesitant about atypical APs -- I do take one for off label reasons as this, the risks of TD is about 5% per year for atypicals up to an unknown point, Seroquel probably being the lowest at around a general risk of 0.1%.
Risperdal has had the only generally known amount of cases at the moment. So if that generally evidence-based view in psychiatry gives any help to you (and I guess I am never really completely reassured myself -- how can one be -- maybe some years from now, but this is what we have in 2008), then one would probably want to stay at the low potency end.
This being {Zyprexa, Seroquel}, which also unfortunately besides fatigue and the weight gain issues [which can vary between the two for anyone] have fewer EPS (extra pyramidal symptoms) or a clinical term for side effects due primarily to APs than more potent APs.
So in conclusion, yes APs + SSRIs are one option.
I don't know what field of business you are in or how much time you have in the day -- that is your privacy and irrelevant to the conversation, but I would conclude finally, that if you can find some "sick days" or use vacation time or however you can get away from what you are doing, CBT can really improve suffering.But only take CBT from reliable sources, such as suggestions from below:
For more information, the OC Foundation, which has been around for more than 20 years, is an extremely reliable primary source for more information on OCD treatments, groups, and other subjects.
It can be found at
This is the end of the thread.
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