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Dr. Bob is Robert Hsiung, MD,
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Posted by fairnymph on August 3, 2002, at 13:55:10
I have OCD and for the past 1.5 years I have been suffering from a major depressive episode (my first ever actually). Because my depression is of the apathetic, sleep too much, eat too much, apathetic sort, it seems to cover my OCD symptoms...it's like I'm too low energy to obsess or be compulsive. I do have anxiety along with my depression, but it tends to manifest itself more as social anxiety.
3 weeks ago I started taking Wellbutrin, 300 mg a day. A few days ago my OCD symptoms started returning in a major way. I haven't obsessed like this in over a year. At the same time, I've also been more productive and had more energy. In some ways I feel like I am beginning to feel like my 'old self' (i.e. how I used to feel for the majority of my life as an un-depressed person).
My depression, however, does not seem to be that much better, in the sense that my mood hasn't noticeably improved. But, I am thinking that perhaps the first sign that the wellbutrin has started to work as an antidepressant is the very fact that my OCD has flared up again.
Do you think that my theory makes any sense? Or do you think that it is merely the stimulating effect of Wellbutrin that is making me a little hyperactive?
I'd appreciate anyone's thoughts. Thanks!
~fairnymph
Posted by Maximus on August 3, 2002, at 20:20:18
In reply to Increased OCD symptoms--sign of lifting deprss'n?, posted by fairnymph on August 3, 2002, at 13:55:10
> 3 weeks ago I started taking Wellbutrin, 300 >mg a day. A few days ago my OCD symptoms started >returning in a major way. I haven't obsessed >like this in over a year. At the same time, I've >also been more productive and had more energy.
What is happening to you is pretty normal. You have probably switched from a SSRI to Wellbutrin. Right? SSRIs are the treatment of choice for OCD. But they tend to cause sometimes (very often in my "book") some lethargy, tiredness, apathy... Now you're taking Wellbutrin. An AD which works a lot on NE and a little bit on DA. In other words Wellbutrin is very energetic. But the downside is that Wellbutrin does not protect you from OCD symptoms.
May i suggest you something? Ask to your doc/pdoc to lower your Wellbutrin and add a low dose of a SSRI (i.e. Paxil, Celexa, etc...). That might does the trick. Who knows?
Hope that helps!
Posted by fairnymph on August 3, 2002, at 20:30:40
In reply to Re: Increased OCD symptoms--sign of lifting deprss'n? » fairnymph, posted by Maximus on August 3, 2002, at 20:20:18
Actually, I haven't been taking an SSRI for over two years now. I was unmedicated for many months before going on Wellbutrin.
I do plan to go on an SSRI in a bit; unfortunately I can't afford it at the moment.
Thanks for the reply,
fairnymph
Posted by Shawn. T. on August 4, 2002, at 2:40:49
In reply to Increased OCD symptoms--sign of lifting deprss'n?, posted by fairnymph on August 3, 2002, at 13:55:10
I believe that Remeron would be a much better choice for you than an SSRI. Because you're already taking Wellbutrin, you won't have to worry about side effects like weight gain. I can overeat all I want and still remain at the same weight. You won't need more than 15mg/day of Remeron when taking it with Wellbutrin. I experienced a similar situation when I started taking Wellbutrin; I became more obsessive than normal. My pdoc and I decided that Remeron would be the best thing for me to take; there really aren't many problems with it in combination with Wellbutrin. He told me that I have an obsessive personality, but I lack the compulsive side. I too had a bit of an increase in anxiety while taking just Wellbutrin (which is somewhat unusual, that side effect should go away after it starts to kick in); Remeron pretty much took care of that problem. Wellbutrin also switched me from generally apathetic to energetic.
If you decide to ignore my advice and take an SSRI, you absolutely must not choose Paxil or Prozac. Both of those drugs interact with Wellbutrin (I know this from both experience and medical journals).
I agree with your theory. After three weeks, you actually have less noradrenaline available in your brain's synapses than you did before taking Wellbutrin. Its mild effects on dopamine can't really be used to explain a switch to OCD behavior. If you told that story to my pdoc, he'd probably put you on Remeron without even giving it much thought.
Shawn
Posted by Ed O`Flaherty on August 4, 2002, at 4:05:37
In reply to Increased OCD symptoms--sign of lifting deprss'n?, posted by fairnymph on August 3, 2002, at 13:55:10
OCD waxes and wanes so it it probably unlikely that there is any connection.Omega-3 fish oil may be if use in OCD and depression and can be added to your present meds.See www.omega3.20megsfree.com
Posted by Kari on August 4, 2002, at 7:29:27
In reply to Increased OCD symptoms--sign of lifting deprss'n?, posted by fairnymph on August 3, 2002, at 13:55:10
Hi,
I had a similar experience following a severe episode of reactive depression which, for the first time in my life, eliminated my usual ocd symptoms. Ironically, the drug which brought them back and enabled me to stand on my feet again was luvox, an SSRI.
It is possible that with the background of faulty biochemistry, ocd might also be a used as a psychological defense to cover up extreme panic, depression and anxiety. Perhaps, on this level, the medication enables a person to regain his regular defenses after they are shattered.
Posted by Maximus on August 4, 2002, at 12:02:02
In reply to Re: Increased OCD symptoms--sign of lifting deprss'n?, posted by Shawn. T. on August 4, 2002, at 2:40:49
The action of Remeron on 5HT2 receptors is simply and purely not enough strong/adequate for OCD symptoms. This is a well known fact. The essential and primary target for treating OCD symptoms is 5HT1A receptors, and Luvox is the best agent as SSRI. Period. Beside that, the vast majority of people gain weight on Remeron. So if you are already overweight it is not such a big deal.
In OCD symptoms, an augmentation of NE is "probably" irrelevant. However even a slight augmentation of DA can trigger OCD symptoms. It is very well established. The cause? I personaly do not know...
But here, don't get me wrong guys. I also find Remeron a great AD with awesome anxiolitic properties. Its heavy sedation property is also great for sleep disturbance in agitated depression. Moreover its other actions on NE are very helpful for the vegetative fonctions of the brain.
Does an AD as add-on can help overcome the side effects of Remeron? Yes for some. But not for the vast majority of people.
And don't forget:
1- Remeron is not an anti-psychotic agent.
2- Remeron can also easily triggers a manic phase
3- Remeron is an "antidepressant".Hope that helps and have a good day!
Posted by fairnymph on August 4, 2002, at 16:36:07
In reply to Re: Increased OCD symptoms--sign of lifting deprss'n?, posted by Shawn. T. on August 4, 2002, at 2:40:49
> I believe that Remeron would be a much better choice for you than an SSRI. Because you're already taking Wellbutrin, you won't have to worry about side effects like weight gain. I can overeat all I want and still remain at the same weight. You won't need more than 15mg/day of Remeron when taking it with Wellbutrin. I experienced a similar situation when I started taking Wellbutrin; I became more obsessive than normal. My pdoc and I decided that Remeron would be the best thing for me to take; there really aren't many problems with it in combination with Wellbutrin. He told me that I have an obsessive personality, but I lack the compulsive side. I too had a bit of an increase in anxiety while taking just Wellbutrin (which is somewhat unusual, that side effect should go away after it starts to kick in); Remeron pretty much took care of that problem. Wellbutrin also switched me from generally apathetic to energetic.
I have tried Remeron before. It is the drug that induced this very depression. It did NOTHING for my OCD. Totally useless. And I am not losing any weight on the wellbutrin -- in fact I think I may have even gained a pound. Anyways, remeron did not work for me. Even at 15 mg/day I was OUT for 14-16 hours at a time, totally incapicated, sedated and fatigued. I hate remeron with a passion! It is the shittiest drug I have ever taken. I think it may be good for others but it is NOT good for me. I cannot gain much weight or I become extremely depressed and suicidal.
>
> If you decide to ignore my advice and take an SSRI, you absolutely must not choose Paxil or Prozac. Both of those drugs interact with Wellbutrin (I know this from both experience and medical journals).My doctor specifically said that remeron was not a good drug for me. I was getting far too many side effects. I plan to go on Zoloft soon, when I can afford it. I have been on prozac before but it scares me -- it took many months for my brain to return to normal. I would never go on paxil because of its sedation/weight gain potential.
>
> I agree with your theory. After three weeks, you actually have less noradrenaline available in your brain's synapses than you did before taking Wellbutrin. Its mild effects on dopamine can't really be used to explain a switch to OCD behavior. If you told that story to my pdoc, he'd probably put you on Remeron without even giving it much thought.
>
thank you for your input here. I was thinking along these lines (in terms of neurotransmitters etc) also.
Posted by Dinah on August 4, 2002, at 21:53:47
In reply to Increased OCD symptoms--sign of lifting deprss'n?, posted by fairnymph on August 3, 2002, at 13:55:10
Fairnymph, I am no expert on neurotransmitters, but I have found that my periods of agitated depression never end without at least one day of pure obsession. One day of pure knotted twisting thoughts and I know I'm starting to look up. I don't understand it, but it seems pretty consistent.
I have OCD too, and haven't found anything to work for it like Luvox. Remeron knocked me out for a weekend, at two different doses, on two different weekends. Wellbutrin and Effexor both triggered nasty agitated hypomanias. Luvox made the OCD disappear and if I ever decide to go back on an SSRI, I think that will be my choice. Unfortunately, I didn't care much for the apathy after 4 years on Luvox.
I do hope in your case the OCD returning is a good sign.
Dinah
(By the way, I find the idea of OCD as a defense mechanism fascinating. I've often toyed with the thought myself.)
Posted by Shawn. T. on August 5, 2002, at 0:51:21
In reply to Re: Increased OCD symptoms--sign of lifting deprss'n?, posted by Ed O`Flaherty on August 4, 2002, at 4:05:37
Good call, Ed. Your suggestion is better than mine, especially under her specific circumstances. I'll find several more links sometime to support your suggestion.
Shawn
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