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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Temoigneur on August 13, 2002, at 17:52:13
Hi I have a ten year history of severe OCD with a severe level of free floating anxiety, and occassional panic attacks. I was convinced I was going to die after a panic attack, having gone through an intensive behavioral program, battling the severe OCD, and I was hospitalised for 6 weeks. During that time I was put on so many meds, 12.5mg zyprexa, 225mg Effexor 80mg prozac, 4mg clonazepam, and 15mg Remeron it's an effort to get out of bed, I have little motivation or interest in anything. Without getting into details, my prospects, for happiness in a relationship are not looking up. I've told my doctor how I'm doing, and he knows, he just tells me it's tough, but I just need to exercise, maintain healthy patterns etc. He says the zyprexa can improve over a six month period - I have noticed some improvement on it, but I'm assuming it, (something I'm taking) is making me extremely tired.
My question is weather it might be worth a trial of an MAOI, as I have never tried any of them before. When I first underwent treatment for OCD, my symptoms improved dramatically for four months with prozac, I was in college, get straight A's, with a full load, (one B), then the effects just seemed to wear off, and the anxiety came back, that was about five years ago, and I've never been really well since.
Does anyone know of a similar situation where a given med such as an MAOI worked, or if it might be worth a try. My neuropsychiatrist says that at best the MAOI would have me feeling the same way I do now, in six months time, (he's a strong proponent of anti depressants taking their full 6-8 weeks to work). When my symptoms were dramatically improved on the prozac years ago, I want so much to feel that way again, but my neuropsychiatrist insists that I shouldn't be looking to feel that way again, and I should move on with this so called "good enough" combination i've been put on. Any imput would be so much appreciated.Thank you
Posted by cybercafe on August 13, 2002, at 18:17:00
In reply to Complicated OCD, MAOI?, posted by Temoigneur on August 13, 2002, at 17:52:13
what is his reasoning to conclude that you can never have complete remission? .... or is it just that he feels it's better to have okay short term gains than really good long term gains
Posted by jsarirose on August 14, 2002, at 0:33:28
In reply to Re: Complicated OCD, MAOI?, posted by cybercafe on August 13, 2002, at 18:17:00
> what is his reasoning to conclude that you can never have complete remission? .... or is it just that he feels it's better to have okay short term gains than really good long term gains
Don't forget about the option of augmenting your drugs. I was on Prozac and had initial success. My doctor added some other drugs (unfortunately it was quite a while ago and I don't remember what) and it seemed to boost the effect.
I agree it's best to give the drug a good run if you can stand it, making sure to go up to the maximum dosage before deciding it doesn't work. I've noticed I seem to need the highest dose for most drugs to get any benefit.
I'm currently on Parnate and Lamictal. I have major long term depression and minor OCD. The OCD doesn't sound nearly as serious as yours, but the Parnate has helped me all around.
-Jessica
Posted by Temoigneur on August 14, 2002, at 4:20:43
In reply to Re: Complicated OCD, MAOI?, posted by jsarirose on August 14, 2002, at 0:33:28
> > >
>
>
>
"Don't forget about the option of augmenting your drugs. I was on Prozac and had initial success. My doctor added some other drugs (unfortunately it was quite a while ago and I don't remember what) and it seemed to boost the effect."
Hi Jessica, thnks so much for your input, I really appreciate it. I've tried augmenting the prozac with a number of things - benzodiazepines, valproate (sp?) acid, buspar - with the klonopin I had dramatic, very short term relief, but gained rapid tolerance to it."what is his reasoning to conclude that you can never have complete remission? .... or is it just that he feels it's better to have okay short term gains than really good long term gains"
- I wonder, and this is highly speculative, but I think that because my situation was so acute, I wonder if he just basically wants a break from the instability, before he tries other agents. On the other hand, it could very well be he doesn't believe I can acheive full remission, and I'm best to accept this, and try and manage the best I can.
However, I still have the memory of the four months in my mind, when my medications where working well, and life was terrific, and can't persuade myself to accept that this is "as good as it gets"
The fact is, that I have tried many agents and they have been unsuccessful - but I've never tried MAOI's - and ironically I've never given clomipramine a fair trial.
> I agree it's best to give the drug a good run if you can stand it, making sure to go up to the maximum dosage before deciding it doesn't work. I've noticed I seem to need the highest dose for most drugs to get any benefit.
I have given the four ssri's a full run, again, with the initial success of prozac, and then more success with luvox over a shorter period, I've been on Tryciclics except clomipramine, thinking back, which did strange things to me, I should think about it perhaps the dose was raised to quickly, at any rate, I've been now on the Zyprexa for nine weeks, and while the "gears in my head" are shifting noticieably easier, I'm always exhausted, and the OCD is still there, I really doubt a five fold improvement will come from waiting a few more weeks. - (not that you were specifically suggesting that in this instance).
The upshot is, I've tried almost every class of drug, and I'm scared, don't know where to turn, if it wasn't for my faith in God I'd be gone.
> I'm currently on Parnate and Lamictal. I have major long term depression and minor OCD. The OCD doesn't sound nearly as serious as yours, but the Parnate has helped me all around.
>
> -JessicaThanks again for taking the time to share that with me, your input is so appreciated, I need to get a spectrum of opinions from people like yourself, before I think about what's ahead
If Anything I've said resonates I would be really grateful to hear about itThanks again,
Ben
Posted by Temoigneur on August 14, 2002, at 4:26:33
In reply to Re: Complicated OCD, MAOI?, posted by cybercafe on August 13, 2002, at 18:17:00
> what is his reasoning to conclude that you can never have complete remission? .... or is it just that he feels it's better to have okay short term gains than really good long term gains
Sorry, I'm new to this, I included your response with the following one, in that posting I said that, "I wonder, and this is highly speculative, but I think that because my situation was so acute, I wonder if he just basically wants a break from the instability, before he tries other agents. On the other hand, it could very well be he doesn't believe I can acheive full remission, and I'm best to accept this, and try and manage the best I can.
However, I still have the memory of the four months in my mind, when my medications where working well, and life was terrific, and can't persuade myself to accept that this is "as good as it gets"
The fact is, that I have tried many agents and they have been unsuccessful - but I've never tried MAOI's - and ironically I've never given clomipramine a fair trial."
Thank you so much for showing interest in my case, your input is so much appreciated I look forward to any future response
Ben
Posted by Temoigneur on August 14, 2002, at 12:06:50
In reply to Re: Complicated OCD, MAOI? » jsarirose, posted by Temoigneur on August 14, 2002, at 4:20:43
In reply to Re: Complicated OCD, MAOI?, posted by jsarirose on August 14, 2002, at 0:33:28
> > >
"Don't forget about the option of augmenting your drugs. I was on Prozac and had initial success. My doctor added some other drugs (unfortunately it was quite a while ago and I don't remember what) and it seemed to boost the effect."
Hi Jessica, thnks so much for your input, I really appreciate it. I've tried augmenting the prozac with a number of things - benzodiazepines, valproate (sp?) acid, buspar - with the klonopin I had dramatic, very short term relief, but gained rapid tolerance to it."what is his reasoning to conclude that you can never have complete remission? .... or is it just that he feels it's better to have okay short term gains than really good long term gains"
- I wonder, and this is highly speculative, but I think that because my situation was so acute, I wonder if he just basically wants a break from the instability, before he tries other agents. On the other hand, it could very well be he doesn't believe I can acheive full remission, and I'm best to accept this, and try and manage the best I can.
However, I still have the memory of the four months in my mind, when my medications where working well, and life was terrific, and can't persuade myself to accept that this is "as good as it gets"
The fact is, that I have tried many agents and they have been unsuccessful - but I've never tried MAOI's - and ironically I've never given clomipramine a fair trial.
> I agree it's best to give the drug a good run if you can stand it, making sure to go up to the maximum dosage before deciding it doesn't work. I've noticed I seem to need the highest dose for most drugs to get any benefit.
I have given the four ssri's a full run, again, with the initial success of prozac, and then more success with luvox over a shorter period, I've been on Tryciclics except clomipramine, thinking back, which did strange things to me, I should think about it perhaps the dose was raised to quickly, at any rate, I've been now on the Zyprexa for nine weeks, and while the "gears in my head" are shifting noticieably easier, I'm always exhausted, and the OCD is still there, I really doubt a five fold improvement will come from waiting a few more weeks. - (not that you were specifically suggesting that in this instance).
The upshot is, I've tried almost every class of drug, and I'm scared, don't know where to turn, if it wasn't for my faith in God I'd be gone.
> I'm currently on Parnate and Lamictal. I have major long term depression and minor OCD. The OCD doesn't sound nearly as serious as yours, but the Parnate has helped me all around.
>
> -JessicaThanks again for taking the time to share that with me, your input is so appreciated, I need to get a spectrum of opinions from people like yourself, before I think about what's ahead
If Anything I've said resonates I would be really grateful to hear about itThanks again,
Ben
Posted by Temoigneur on August 14, 2002, at 12:08:33
In reply to Re: Complicated OCD, MAOI?, posted by cybercafe on August 13, 2002, at 18:17:00
In reply to Re: Complicated OCD, MAOI?, posted by cybercafe on August 13, 2002, at 18:17:00
> what is his reasoning to conclude that you can never have complete remission? .... or is it just that he feels it's better to have okay short term gains than really good long term gains
Sorry, I'm new to this, I included your response with the following one, in that posting I said that, "I wonder, and this is highly speculative, but I think that because my situation was so acute, I wonder if he just basically wants a break from the instability, before he tries other agents. On the other hand, it could very well be he doesn't believe I can acheive full remission, and I'm best to accept this, and try and manage the best I can.
However, I still have the memory of the four months in my mind, when my medications where working well, and life was terrific, and can't persuade myself to accept that this is "as good as it gets"
The fact is, that I have tried many agents and they have been unsuccessful - but I've never tried MAOI's - and ironically I've never given clomipramine a fair trial."
Thank you so much for showing interest in my case, your input is so much appreciated I look forward to any future response
Ben
Posted by cybercafe on August 14, 2002, at 13:25:50
In reply to Re: Complicated OCD, MAOI? » cybercafe, posted by Temoigneur on August 14, 2002, at 4:26:33
> However, I still have the memory of the four months in my mind, when my medications where working well, and life was terrific, and can't persuade myself to accept that this is "as good as it gets"
.... i dunno... i imagine there are some patients out there who would find it devastating to have to start over on a new med ....
... i can't tell you that MAOIs are the drugs for you.... but i'd like to think i could make you feel a little better by telling you that i thought i had no chance in hell of resolving the majority of my symptoms... and now i feel much much better.. without even side effects like sedation or weight gain or sexual side effects ....
> The fact is, that I have tried many agents and they have been unsuccessful - but I've never tried MAOI's - and ironically I've never given clomipramine a fair trial."... god there are so many drugs out there... it's hard to believe anyone has found the best drug for them.... i'm sure most of us wont... due to time constraints... but at the same time... i'd like to think most of us will still be able to feel happy happy happy with minimal (i.e. you pretty much forget about them) side effects...
> Thank you so much for showing interest in my case, your input is so much appreciated I look forward to any future response
... well ... if you suffered from terminal cancer or something i would find that hard to deal with... but with mental illness it seems so positive and inspiring to be able to see people change their lives around so easily when they find the right drug ..... or even if you have to live with a partial response... i've always been grateful for my partial responses :)
Posted by jsarirose on August 14, 2002, at 13:40:53
In reply to Re: Complicated OCD, MAOI?, posted by Temoigneur on August 14, 2002, at 12:08:33
> However, I still have the memory of the four months in my mind, when my medications where working well, and life was terrific, and can't persuade myself to accept that this is "as good as it gets"
>
> The fact is, that I have tried many agents and they have been unsuccessful - but I've never tried MAOI's - and ironically I've never given clomipramine a fair trial."
>
I completely understand what you mean about trying to get back to that illusive feeling that you had for 4 months. I've had depression for 25 years now, about 8 years ago I had about a 1.5 year "normal" period from the right combo of meds. Eventually the combo stopped being as effective and I started plummeting again. Since then when I felt like giving up I remember what it felt like to be almost "normal". It discouraged me and gave me hope at the same time.I wouldn't necessarily recommend an MAOI until you feel you have tried most of the other options available in the tricyclic and SSRI families. It is a harder drug to take with the diet restrictions, blood pressure side effects, and potential dangers. (Not to scare you, it's definitely doable.)
Here's a great article on Treatment Resistent Depression and the best path to follow for exploring meds. It actually gave me more faith in my doctor when I realized she had basically been following this framework.
http://www.acnp.org/g4/GN401000105/Default.htm
-Jessica
Posted by Mr. Scott on August 15, 2002, at 4:04:50
In reply to Complicated OCD, MAOI?, posted by Temoigneur on August 13, 2002, at 17:52:13
hmmm...When was the last time you were off all antidepressants? Did you notice a worsening or improvement of your OCD?
Scott
This is the end of the thread.
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