![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by g_g_g_unit on December 6, 2011, at 2:44:14
Hey Phidippus,
I was wondering which single med - other than clomipramine (which I couldn't tolerate) - has provided you with the most relief from OCD? Do you feel Namenda has played a significant role?
Thanks
David
Posted by Phidippus on December 7, 2011, at 15:57:42
In reply to question for phidippus, posted by g_g_g_unit on December 6, 2011, at 2:44:14
There have been three ADs I have taken which have provided about equivalent relief from my OCD symptoms: Clomipramine, Mirtazapine and Viibryd. Clomipramine is by far the most effective, but had the most side effects. Mirtazapine provided effective relief, but made me manic. Viibryd has had a nice soothing effect, but has fallen short in some areas.
Now, I have severe OCD, so I had to augment my treatment with other medications. I went through all the atypicals and finally settled Invega for a while, which really helped with intrusive thoughts. Akathisia drove me to Latuda and I've been very happpy with it. Keeps me from going manic from AD therapy and calms the OCD.
What's left over is a lot of intrusive suicidal thinking and I aim to treat that by further augmenting my OCD treatment. Of these augmentation strategies, Lyrica and Prazosin have worked best. Namenda doesn't seem to be strong enough.
I know you're having a hard time getting your anxiety under control and it seems like I'm dogging you, but I have the best intentions. I want you to get better.
Concentrate on sticking to the Lexapro and continue raising the dose. If anxiety remains, find an AAP that works for you-something with a stronge dopamine profile.
Eric
Posted by g_g_g_unit on December 10, 2011, at 7:24:01
In reply to Re: question for phidippus » g_g_g_unit, posted by Phidippus on December 7, 2011, at 15:57:42
> There have been three ADs I have taken which have provided about equivalent relief from my OCD symptoms: Clomipramine, Mirtazapine and Viibryd. Clomipramine is by far the most effective, but had the most side effects. Mirtazapine provided effective relief, but made me manic. Viibryd has had a nice soothing effect, but has fallen short in some areas.
>
> Now, I have severe OCD, so I had to augment my treatment with other medications. I went through all the atypicals and finally settled Invega for a while, which really helped with intrusive thoughts. Akathisia drove me to Latuda and I've been very happpy with it. Keeps me from going manic from AD therapy and calms the OCD.
>
> What's left over is a lot of intrusive suicidal thinking and I aim to treat that by further augmenting my OCD treatment. Of these augmentation strategies, Lyrica and Prazosin have worked best. Namenda doesn't seem to be strong enough.
>
> I know you're having a hard time getting your anxiety under control and it seems like I'm dogging you, but I have the best intentions. I want you to get better.
>
> Concentrate on sticking to the Lexapro and continue raising the dose. If anxiety remains, find an AAP that works for you-something with a stronge dopamine profile.
>
> EricThanks for your help, Eric. Unfortunately, Clomipramine caused intolerable anxiety and agitation .. if all else fails, it may be worth revisiting with something to smooth out the SE's.
Mirtazapine, on the other hand, was hands down the most excruciating experience I've had on a med. It make me dysphoric, anxious, ratcheted up my OCD to unbearable proportions. I was so young at the time - 18 or so - and had been left home alone by my parents for two weeks. I was quite new to medication at that stage and not particularly adept at linking a worsening in my condition to a particular medication, dose increase, etc. All I remember is making arrangements to have myself institutionalized, which thankfully never materialized. Anyway, did you take it in combination with an SRI? I was on it as monotherapy.
I know you're looking out for me and I appreciate it. You just have to understand that I'm still at a formative age (26) and I'm scared. I avoided medication and kept myself in a state of near-insanity for years because I was trying to preserve a career as a writer; I just can't write on meds, nor do I think I could to do something requiring the intellectual heavy-lifting of post-graduate... at least not on SSRIs alone, which really do make my ADD a nightmare (brain fog, spaciness), and I'm really not exaggerating there. Maybe you could correct me on my hesitation about meds. I just feel stuck .. new country, no friends other than one I knew from where I previously lived, no real prospects at this point .. I know I am really, really sick but I just don't see meds as enabling me. Again, I'm fully copping to the fact that I may have some bias which needs correcting. But I've just been filled with thoughts of suicide as of late. I know there's an OC-component to them - like you perhaps - because I find myself weighing up, almost mathematically, whether it's worth living or dying, like it's an equation that could be solved.
Posted by Phidippus on December 10, 2011, at 18:01:56
In reply to Re: question for phidippus » Phidippus, posted by g_g_g_unit on December 10, 2011, at 7:24:01
>Clomipramine caused intolerable anxiety and >agitation
That can happen with Clomipramine.
>Anyway, did you take it in combination with an >SRI? I was on it as monotherapy.
At one point I was on Lithium, Mirtazapine, Invega and Vyvanse. I kept on having mixed episodes which I had to quell with Seroquel. Otherwise Mirtazapine was an effective treatment for my OCD.
>I avoided medication and kept myself in a state >of near-insanity for years because I was trying >to preserve a career as a writer
It is a common assertation that medicines zap the creative spirit. What I've found is if you're on the right meds, your SYMPTOMS don't get in the way of your creativity. But, I know what's its like to be on meds that make you feel retarded. If it helps any, I find your posts to be well worded and very telling.
>I'm still at a formative age (26) and I'm scared.
There's nothing to fear except fear itself.
>I just can't write on meds, nor do I think I >could to do something requiring the intellectual >heavy-lifting of post-graduate...
Trust me, you can, it just takes a little more effort. I'm pre-med and my brain works half the time because of symptoms or meds, yet I maintain a high GPA and still have time to play Call of Duty.
Sometimes you just have to compromise.
>at least not on SSRIs alone, which really do >make my ADD a nightmare
Some folk augment their ADHD treatment by taking an SNRI, like Effexor. Have you ever been on an SNRI?
Another something I can think of is augmenting your ADHD treatment with something like Straterra or Intuniv-this might actually help with anxiety. There's also Focalin, Wellbutrin and Nuvigil.
>Maybe you could correct me on my hesitation >about meds.
Here's the secret about OCD. It makes you miserable but it does not kill you or cause any lasting brain damage. Once you know that you can look at treating the illness with less trepidation-imagine all the drugs you get to try! When I was diagnosed with OCD, the first thing I focused on was conquering my anxiety of taking medication. At one point, I just started trying everything. Some things made me more misrable (f*ck Prozac) and somethings I continue to take beccause they helped so much (Clomipramine). The one thing I kept in mind is I wasn't going to die from the OCD, even if by my own hands.
>I just feel stuck .. new country, no friends >other than one I knew from where I previously >lived, no real prospects at this point
What country are you in?
And you're not stuck. I think you're making progress with the Lexapro. You seem to be sticking it out.
>I know I am really, really sick but I just don't see meds as enabling me.
I think the OCD has you convinced you're really sick. OR you're worried sick.
>But I've just been filled with thoughts of >suicide as of late.
If I had a dollar for every suicidal ideation I've had, I'd be very rich and able to pay someone else to worry about such stupid things.
Have you ever been in therapy with a therapist who specializes in anxiety disorders, OCD especially and ERP? You might do well with the right therapy.
Eric
Posted by g_g_g_unit on December 12, 2011, at 5:07:38
In reply to Re: question for phidippus » g_g_g_unit, posted by Phidippus on December 10, 2011, at 18:01:56
> >Clomipramine caused intolerable anxiety and >agitation
>
> That can happen with Clomipramine.In that case, would you suggest augmenting Clomipramine - and if so, with what?
>
> >Anyway, did you take it in combination with an >SRI? I was on it as monotherapy.
>> >I avoided medication and kept myself in a state >of near-insanity for years because I was trying >to preserve a career as a writer
>
> It is a common assertation that medicines zap the creative spirit. What I've found is if you're on the right meds, your SYMPTOMS don't get in the way of your creativity. But, I know what's its like to be on meds that make you feel retarded. If it helps any, I find your posts to be well worded and very telling.I appreciate the compliment. Unfortunately, I've yet to find a combination that keeps me in a sufficiently hedonic and cognitively intact state to keep creating .. let alone functioning, really.
>
> >I just can't write on meds, nor do I think I >could to do something requiring the intellectual >heavy-lifting of post-graduate...
>
> Trust me, you can, it just takes a little more effort. I'm pre-med and my brain works half the time because of symptoms or meds, yet I maintain a high GPA and still have time to play Call of Duty.I take my hat off to you, good sir. The fact that you're pre-med with your dx. really is impressive and inspires me, though bear in mind that certain fields (like the arts) might be less conducive to the cognitive enhancement afforded by things like stimulants.
>
> Sometimes you just have to compromise.
>
> >at least not on SSRIs alone, which really do >make my ADD a nightmare
>
> Some folk augment their ADHD treatment by taking an SNRI, like Effexor. Have you ever been on an SNRI?No, I haven't.
>
> Another something I can think of is augmenting your ADHD treatment with something like Straterra or Intuniv-this might actually help with anxiety. There's also Focalin, Wellbutrin and Nuvigil.Strattera caused intolerate anxiety (all NRI agents seem to). Intuniv and Focalin aren't available in Australia. I was under the impression Pro/Nuvigil made OCD worse?
>
> >Maybe you could correct me on my hesitation >about meds.
>
> Here's the secret about OCD. It makes you miserable but it does not kill you or cause any lasting brain damage. Once you know that you can look at treating the illness with less trepidation-imagine all the drugs you get to try! When I was diagnosed with OCD, the first thing I focused on was conquering my anxiety of taking medication. At one point, I just started trying everything. Some things made me more misrable (f*ck Prozac) and somethings I continue to take beccause they helped so much (Clomipramine). The one thing I kept in mind is I wasn't going to die from the OCD, even if by my own hands.
>
> >I just feel stuck .. new country, no friends >other than one I knew from where I previously >lived, no real prospects at this point
>
> What country are you in?Australia
>
> And you're not stuck. I think you're making progress with the Lexapro. You seem to be sticking it out.
>
> >I know I am really, really sick but I just don't see meds as enabling me.
>
> I think the OCD has you convinced you're really sick. OR you're worried sick.Well I am sick BECAUSE of the OCD. The amount of phobic avoidance I engage in leaves me with 10% of a life.
>
> >But I've just been filled with thoughts of >suicide as of late.
>
> If I had a dollar for every suicidal ideation I've had, I'd be very rich and able to pay someone else to worry about such stupid things.
>
> Have you ever been in therapy with a therapist who specializes in anxiety disorders, OCD especially and ERP? You might do well with the right therapy.
>Yes. I can't afford to see someone locally but I am in contact with a student via Skype at Dr Phillipson's OCD treatment centre in New York. They're kind of helpful, but I really feel like I need a qualified therapist to untangle the utter mess that is my OCD.
Posted by Phidippus on December 13, 2011, at 18:13:01
In reply to Re: question for phidippus » Phidippus, posted by g_g_g_unit on December 12, 2011, at 5:07:38
>In that case, would you suggest augmenting >Clomipramine - and if so, with what?
Augmenting any SSRI with Clomipramine is recommended by the APA treatment guideline for OCD. You could easily add it to your Lexapro regimen.
>Unfortunately, I've yet to find a combination >that keeps me in a sufficiently hedonic and >cognitively intact state to keep creating .. let >alone functioning, really.
Keep pushing with the lexapro. Get it up to 40 mg. Fight the akathisia. Once you're on a an AD for a while, a lot of augmentation strategies become open to you.
>What's the longest you've been on any AD?
>Have you ever been on an SNRI?
>No, I haven't.
Keep it in mind for the future. An SNRI may actually augment your ADHD treatment and you won't suffer the attentional difficulties you experience on SSRIs.
>I was under the impression Pro/Nuvigil made OCD >worse?
It had no effect on my OCD.
>Well I am sick BECAUSE of the OCD. The amount of >phobic avoidance I engage in leaves me with 10% >of a life.
Ouch, you really do need some exposure therapy.
>I really feel like I need a qualified therapist >to untangle the utter mess that is my OCD.
I think you do to.
Eric
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.