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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by sukarno on April 3, 2010, at 14:58:47
In reply to I think I just want control..., posted by linkadge on April 2, 2010, at 20:16:56
It's interesting that you mentioned that about high dopamine activity when depressed. I think you hit the nail right on the head. I have OCPD (Obsessive Compulsive Personality Disorder), which is basically (or should be better known as) Perfectionistic Personality Disorder. I read a medical abstract that showed high dopamine activity in the dopamine D2 and D3 receptors in folks with OCPD. The D3 receptor is associated with compulsions.
Seventy percent of people with OCPD suffer from depression too and anxiety.
Posted by linkadge on April 3, 2010, at 14:58:47
In reply to OCPD and overactivity of dopamine D2/D3 receptors, posted by sukarno on April 2, 2010, at 20:39:43
I'm a perfectionist too and this is what confuses my diagnosis.
Some people might put it in the bipolar spectrum since I seem to find the energy to keep doing things till I get them right. I obsess a lot and ruminate. I won't eat anything that is the slightest bit unhealthy. I don't spend any money.
I want control and I am not afraid to admit it. I don't know how to let go.
Posted by SLS on April 3, 2010, at 14:58:47
In reply to OCPD and overactivity of dopamine D2/D3 receptors, posted by sukarno on April 2, 2010, at 20:39:43
> I read a medical abstract that showed high dopamine activity in the dopamine D2 and D3 receptors in folks with OCPD. The D3 receptor is associated with compulsions.
Might the increased activity in these dopaminergic pathways actually be secondary to overactive noradrenergic activity arising from the locus ceruleus? I don't know.
Perfectionism had been a large component of my personality. I have pretty much freed myself of it through psychotherapeutics.
- Scott
Posted by SLS on April 3, 2010, at 14:58:47
In reply to Re: OCPD and overactivity of dopamine D2/D3 receptors, posted by SLS on April 3, 2010, at 6:13:50
> Perfectionism had been a large component of my personality. I have pretty much freed myself of it through psychotherapeutics.
Soon, I will conquer in completely. I won't rest until I do.
- Scott
Posted by sukarno on April 3, 2010, at 14:58:48
In reply to Re: OCPD and overactivity of dopamine D2/D3 receptors, posted by SLS on April 3, 2010, at 6:24:41
I think I made a mistake in posting as I read the abstract again and it only mentioned the D3 receptor. Something to do with gene polymorphisms and overactivity of D3.. a bit over my head, but I get the general idea of it. Something could be wrong with our D3 receptor.
I guess this means that Mirapex is a bad idea for treating depression or low sex drive?
I was thinking of trialling Mirapex at a low dose of 0.0625mg - 0.125mg once per day.
My other option is Zoloft, but I know that if I get on SSRIs that it will be (likely) a long term relationship and might give me another GI bleed like Prozac did. Serotonin reuptake seems to increase the risk of upper GI bleeding by 2 to 7 fold, especially if you take aspirin or other NSAIDs with it or are on anti-platelet medication.
It was suggested that taking an H2 receptor antagonist such as ranitidine (Zantac) or famotidine (Pepcid) or a proton pump inhibitor might lessen the risk. I think the study showed that it did indeed lessen the risk.
I know you can take Mirapex with Zoloft. Sometimes that is prescribed to help restore sexual function to some degree, but watch out for compulsive gambling.If we are OCPD, then perhaps Mirapex or any other D2/D3 agonist would be a bad idea?
My psychiatrist said to take Abilify and I said, "no way", so he suggested high dose Zoloft to control OCPD.
He didn't want to hear anything about non-medical strategies and said he can do all the psychotherapy himself, even though I mentioned that perhaps a counselor who specialises in OCPD might be best. "Just come to me and talk about it.. take Zoloft 50mg for the first week and then 100mg the next week". ugh.
I have held back from doing that. I wonder what Mirapex would do... would it make me excessively perfectionist?
Posted by sukarno on April 3, 2010, at 14:58:48
In reply to Re: OCPD and overactivity of dopamine D2/D3 receptors, posted by sukarno on April 3, 2010, at 9:34:28
"Serotonin reuptake seems to increase the risk of upper GI bleeding by 2 to 7 fold, especially if you take aspirin or other NSAIDs with it or are on anti-platelet medication."
Sorry, should have said "serotonin reuptake inhibition".
Posted by SLS on April 3, 2010, at 14:58:48
In reply to Re: OCPD and overactivity of dopamine D2/D3 receptors, posted by sukarno on April 3, 2010, at 9:34:28
What have you found in your research regarding the use of Zoloft to treat OCPD? Is there any precedent to support this strategy?
- Scott----------------------------------------------
High-Dose Sertraline Strategy for Nonresponders to Acute Treatment for Obsessive-Compulsive Disorder: A Multicenter Double-Blind Trial
Ninan PT, Koran LM, Kiev A
J Clin Psychiatry
vol. 67, 15 - 22, 2006
view at publisher
AbstractObjective:
To evaluate the efficacy and safety of high-dose sertraline for patients with obsessive-compulsive disorder (OCD) who failed to respond to standard sertraline acute treatment.
Method:
Sixty-six nonresponders to 16 weeks of sertraline treatment who met DSM-III-R criteria for current OCD were randomly assigned, in a double-blind continuation phase of a multicenter trial, either to continue on 200 mg/day of sertraline or to increase their dose to between 250 and 400 mg/day for 12 additional weeks. Efficacy measures included the Yale-Brown Obsessive Compulsive Scale (YBOCS), the National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH Global OC Scale), and the Clinical Global Impressions-Severity of Illness and -Improvement (CGII) scales. Data were collected from July 26, 1994, to October 26, 1995.
Results:
The high-dose (250-400 mg/day, mean final dose = 357, SD = 60, N = 30) group showed significantly greater symptom improvement than the 200-mg/day group (N = 36) as measured by the YBOCS (p = .033), NIMH Global OC Scale (p = .003), and CGI-I (p = .011). Responder rates (decrease in YBOCS score of ≥ 25% and a CGI-I rating ≥ 3) were not significantly different for the 200-mg/day versus the high-dose sertraline group, either on completcr analysis, 34% versus 52%, or on endpoint analysis, 33% versus 40%. Both treatments showed similar adverse event rates.
Conclusion:
Greater symptom improvement was seen in the high-dose sertraline group compared to the 200-mg/day dose group during continuation treatment. Both dosages yielded similar safety profiles. Administration of higher than labeled doses of selective serotonin reuptake inhibitors may be a treatment option for certain OCD patients who fail to respond to standard acute treatment.
Posted by Brainbeard on May 25, 2010, at 6:13:04
In reply to should have said 'serotonin reuptake inhibition', posted by sukarno on April 3, 2010, at 14:58:48
> "Serotonin reuptake seems to increase the risk of upper GI bleeding by 2 to 7 fold, especially if you take aspirin or other NSAIDs with it or are on anti-platelet medication."
>
> Sorry, should have said "serotonin reuptake inhibition".You perfectionist!! ;)
This is the end of the thread.
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