![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by leeran on June 14, 2003, at 21:42:13
I guess you could say that I'm obsessively looking for "best" OCD medication.
My OCD tendencies go into full throttle during times of stress - and the last few weeks have been some of the most stressful in my life.
I'm currently on:
Adderall
Lexapro
Wellbutrin
Ambien
Natural hormones (prescribed)However, it's obvious to my husband (and yes, to me . . . ) that my OCD tendencies have been a bit out of hand here lately.
Any suggestions are greatly appreciated!
It seems like I read of one particular medication that sounded hopeful here in the last few months - but try as I might - I can't think of the name.
Thanks so much!
Posted by hawkeye on June 14, 2003, at 22:24:08
In reply to Obsessively looking for best OCD medication, posted by leeran on June 14, 2003, at 21:42:13
Take a look at Luvox. It was approved for OCD before it was used for depression.
Posted by JMD on June 14, 2003, at 23:24:40
In reply to Re: Obsessively looking for best OCD medication, posted by hawkeye on June 14, 2003, at 22:24:08
> Take a look at Luvox. It was approved for OCD before it was used for depression.
My psychiatrist wanted me to try Luvox. I feel I had a bad experience w/ it. I was showing signs of "disinhibition." When, in conjunction with a lot of other life stressors, I actually became violent, I dropped it immediately. This sis only one man's experience.
Posted by Caleb462 on June 15, 2003, at 1:48:22
In reply to Obsessively looking for best OCD medication, posted by leeran on June 14, 2003, at 21:42:13
Anafranil (Clomipramine) is the classic OCD medication, often called the "gold standard". It is a tricyclic, meaning it has sedating and anti-chollinergic side effects, but it is quite possibly not only the best OCD med out there, but one of the best anti-depressants as well. It's an extremely potent inhibitor of serotonin reuptake, and it's metabolite, desmethylclomipramine, is a potent norepinephrine uptake inhibitor. Clomipramine is also a 5-HT2a antagonist. Thus you get multiple Anti-depressant/Anti-obsessional effects from the same drug.
Doesn't work for everyone though, but some patients who don't respond to SSRIs respond to Anafranil.
Personally, I just added Anafranil to my regimen. Started at 25 mg, and am now 50 mg - which is where I'll be staying for a while. Too early to tell what effect it will have on my OCD. I am also on 225 mg Effexor, and 100 mg Seroquel at night.
There's also the atypical anti-psychotics, a percentage of people with OCD respond well to these when they are combined with SSRI/SRI therapy. I believe Zyprexa and Risperdal are the most commonly used agents.. but there is also Geodon, Seroquel, Abilify, and Clozaril. Of course with these you have to consider issues such as Weight Gain, Diabetes, and Tardive Dyskenia... but they are a good choice for some folks.
I belive Buspar augmentation is also helpful for a few OCD patients, and a minority of patients respond to Klonopin augmentation as well.
And of course, there's Nardil - an MAOI.
There's more, just can't remember right now.
Anyway.. good luck, I know how hard OCD can be.
Posted by leeran on June 15, 2003, at 1:54:45
In reply to Re: Obsessively looking for best OCD medication, posted by Caleb462 on June 15, 2003, at 1:48:22
Thanks to EVERYONE who has responded so far!
Now, here's the next PITA question . . . do some of these cause more (or less) weight gain?
I always hate to take anything that might contribute to weight gain.
Ahhhh, it's such a delicate balance - trying to find the right combination of chemicals.
Thanks again everyone!!!
(And more responses are, of course, eagerly welcomed!)
Posted by Caleb462 on June 15, 2003, at 2:02:06
In reply to Re: Obsessively looking for best OCD medication, posted by JMD on June 14, 2003, at 23:24:40
Luvox works for some, certainly... but there's no reason to believe its any better than any of the other SSRIs for treating OCD. That's simply the approval the company went for when presenting the product to the FDA.
Posted by Ed O`Flaherty on June 15, 2003, at 6:43:57
In reply to About Luvox, posted by Caleb462 on June 15, 2003, at 2:02:06
SSRIs like Prozac and Luvox,often in very high doses, are the mainstay of OCD treatment nowadays.Anafranil has been widely used for many years too but it does put on a lot of weight. I have seen several patients who have done well by adding omega-3 fish oil to their meds and report on them at www.omega3.20megsfree.com
Posted by Dinah on June 15, 2003, at 14:04:37
In reply to Obsessively looking for best OCD medication, posted by leeran on June 14, 2003, at 21:42:13
Luvox was great for the obsessions. But like someone else mentioned, it did have a disinhibiting effect on my SI urges. And also a flattening of emotions (which short term can be pretty good sometimes). And four years with no orgasms.
It did help stop the obsessions though.
Posted by leeran on June 15, 2003, at 16:35:55
In reply to Re: Obsessively looking for best OCD medication, posted by Caleb462 on June 15, 2003, at 1:48:22
Caleb,
I just want to thank you for your in-depth post. I just read it over again and I'm really grateful for your easy-to-understand synopsis!
Yes, OCD is frustrating. It never USED to be because, quite honestly, I didn't realize I "had it." I just thought the way I behaved was "normal" (at least for me).
In my case, OCD has been a friend and a foe. It can be a driving force and now, I recognize the role it played during the years of my very high-stress career - yet, lately, it has deteriorated into one rather destructive (physically) behavior that I need to get in check.
I hope the Anafranil works for you. I'll keep a "look-out" for your posts.
Thanks again!
Lee
Posted by avid abulia on June 15, 2003, at 16:47:38
In reply to Re: Obsessively looking for best OCD medication, posted by JMD on June 14, 2003, at 23:24:40
> > Take a look at Luvox. It was approved for OCD before it was used for depression.
>
> My psychiatrist wanted me to try Luvox. I feel I had a bad experience w/ it. I was showing signs of "disinhibition." When, in conjunction with a lot of other life stressors, I actually became violent, I dropped it immediately. This sis only one man's experience.
>and it was this man`s experience, as well. on other SSRIs i *just* wanted to kill myself, but on this one i wanted to kill everyone else, too.
~AA
Posted by leeran on June 15, 2003, at 17:35:58
In reply to Re: Obsessively looking for best OCD medication » JMD, posted by avid abulia on June 15, 2003, at 16:47:38
My ex-husband was on Luvox for awhile. I found him to be even nastier to be around and more aggressive while on this medication.
Thanks for your input!
Posted by McPac on June 15, 2003, at 19:16:11
In reply to Re: Obsessively looking for best OCD medication » JMD, posted by avid abulia on June 15, 2003, at 16:47:38
I have talked about the anger/rage/irritability that many meds, especially the ssri's cause, for some time. Remarkable how many people have felt that way from these "safer, less side effects" newer drugs (major sarcasm!).
Posted by avid abulia on June 16, 2003, at 0:05:34
In reply to Re: Obsessively looking for best OCD medication, posted by McPac on June 15, 2003, at 19:16:11
> I have talked about the anger/rage/irritability that many meds, especially the ssri's cause, for some time. Remarkable how many people have felt that way from these "safer, less side effects" newer drugs (major sarcasm!).
yeah, i have noticed the same thing, both with friends and on other boards. i have come to the conclusion that if anyone has ever done well and not gotten worse on an SSRI i have yet to meet them.
~AA
Posted by BekkaH on June 16, 2003, at 0:32:53
In reply to Re: Obsessively looking for best OCD medication, posted by avid abulia on June 16, 2003, at 0:05:34
> > > yeah, i have noticed the same thing, both with friends and on other boards. i have come to the conclusion that if anyone has ever done well and not gotten worse on an SSRI i have yet to meet them.> ~AA
>
>
************************************************I agree 100%. Actually, I didn't experience enough anger on ssri's. I became apathetic and lethargic on all ssri's, especially Celexa, and within a short time I stopped caring that I didn't care. That is worse than depression. At least when I'm depressed but not on an ssri, I still give a damn, I still care, and I still have a personality. I think that many doctors like ssri's because patients become so complacent, compliant and wimpy on them that they are less likely to complain and bother their doctors.
Posted by ace on June 16, 2003, at 0:49:02
In reply to Re: Obsessively looking for best OCD medication, posted by Caleb462 on June 15, 2003, at 1:48:22
> Anafranil (Clomipramine) is the classic OCD medication, often called the "gold standard". It is a tricyclic, meaning it has sedating and anti-chollinergic side effects, but it is quite possibly not only the best OCD med out there, but one of the best anti-depressants as well. It's an extremely potent inhibitor of serotonin reuptake, and it's metabolite, desmethylclomipramine, is a potent norepinephrine uptake inhibitor. Clomipramine is also a 5-HT2a antagonist. Thus you get multiple Anti-depressant/Anti-obsessional effects from the same drug.
>
> Doesn't work for everyone though, but some patients who don't respond to SSRIs respond to Anafranil.
>
> Personally, I just added Anafranil to my regimen. Started at 25 mg, and am now 50 mg - which is where I'll be staying for a while. Too early to tell what effect it will have on my OCD. I am also on 225 mg Effexor, and 100 mg Seroquel at night.
>
> There's also the atypical anti-psychotics, a percentage of people with OCD respond well to these when they are combined with SSRI/SRI therapy. I believe Zyprexa and Risperdal are the most commonly used agents.. but there is also Geodon, Seroquel, Abilify, and Clozaril. Of course with these you have to consider issues such as Weight Gain, Diabetes, and Tardive Dyskenia... but they are a good choice for some folks.
>
> I belive Buspar augmentation is also helpful for a few OCD patients, and a minority of patients respond to Klonopin augmentation as well.
>
> And of course, there's Nardil - an MAOI.
>
> There's more, just can't remember right now.
>
> Anyway.. good luck, I know how hard OCD can be.Just thought I'd add Parnate can work REAL well too - Michael Jenike has a paper out somewhere in which Parnate provided 100% relief from OCD.
Ace.
Posted by leeran on June 16, 2003, at 0:51:16
In reply to Re: Obsessively looking for best OCD medication, posted by ace on June 16, 2003, at 0:49:02
Thanks so much, Ace!
I have read many of your posts.
Are you currently on Parnate right now? I remember you made a switch a few weeks ago.
Best,
Lee
Posted by BekkaH on June 16, 2003, at 0:58:07
In reply to Obsessively looking for best OCD medication, posted by leeran on June 14, 2003, at 21:42:13
Hello Lee,
Unfortunately, I cannot recommend a medication for OCD; however, I see that you are on both Adderall and Wellbutrin. I was much more obsessive-compulsive when I was on Adderall. It was so bad that it was completely counterproductive. Some people report "hyper-focusing" on Adderall, and I noticed that as well, although I referred to it as "fixation" more than "hyper-focusing," but it's essentially the same idea. It became increasingly difficult to see the forest through the trees. I experienced similar problems on Wellbutrin, and I think I would have gone mad if I had been on Wellbutrin and Adderall together. I think Dexedrine was much less likely to cause obsessional behavior. Have you increased the dose of either Adderall or Wellbutrin lately? Perhaps you and your doctor can discuss decreasing the dose of one of those two medications to see whether that helps alleviate some of the OCD? Some doctors suggest changing only one variable at a time so you can see which medicine is causing a particular symptom. Your body chemistry may be able to tolerate a lot more polypharmacy than mine can, but sometimes I think it's best to subtract a drug or lower the dose before adding yet another one to the mixture. If you are able to manage by adjusting or lowering the Adderall and/or Wellbutrin dosages, you may not even need to add an OCD med!
By the way, a couple of weeks ago, I read the long post you wrote about your son on the social board. What a wonderful post that was! You write beautifully. I wonder whether you have ever considered writing professionally?
Bekka
Posted by leeran on June 16, 2003, at 1:08:31
In reply to Obsessively looking - leeran, posted by BekkaH on June 16, 2003, at 0:58:07
BekkaH,
Thanks so much for your input! I've wondered about the Adderall . . . more than anything else - I think this has to do with feeling so out of control right now and basically being in limbo until this is all settled with what will be happening.
After "running the show" for fifteen years, I suddenly feel like I've been forced onto the sidelines and I find myself doing "things" to try to combat what I guess would be described as a feeling of dysphoria.
Re: combinations - yes, my psychiatrist changes dosages one at a time.
I actually think I would have been much further along had this incident not cropped up so suddenly. It's really thrown me off track.
My husband finally intervened on my most destructive behavior on Friday evening (no, not drinking/smoking or drugs - but something that is, indeed, self-destructive and obsessive). He mentioned therapy - as did my mom tonight on the phone - but my psychiatrist really doesn't think that I need therapy (I suppose my years in sales have made it easy for me to put on a "happy face" when I'm out and about).
Thanks so very much for replying, and moreover, thanks for your comments on my writing.
I went to college with a creative writing scholarship, but then I fell in the advertising end of the business and now - after many years in that profession - I am totally burnt out and tired of what I do.
Writing is often a way to ease my angst and finally, in my early forties, I see the real value in journaling.
Thanks again!
Lee
Posted by Questionmark on June 16, 2003, at 4:46:34
In reply to Obsessively looking - leeran, posted by BekkaH on June 16, 2003, at 0:58:07
First, Caleb, you said "Clomipramine is also a 5-HT2a antagonist. Thus you get multiple Anti-depressant/Anti-obsessional effects from the same drug." i thought 5-HT2 (including 5-HT2a i think) agonism helps obsessive-compulsive tendencies and 5-HT2 antagonism aggravates OC stuff. Am i wrong on this or are you (/him)? Please, i'm really curious about this.
BekkaH said:
> "I was much more obsessive-compulsive when I was on Adderall. It was so bad that it was completely counterproductive. Some people report "hyper-focusing" on Adderall, and I noticed that as well, although I referred to it as "fixation" more than "hyper-focusing," but it's essentially the same idea. It became increasingly difficult to see the forest through the trees."
That is SUCH a brilliant explanation of the worsening of obsessive-compulsiveness caused by stimulants. i've been trying to think how to describe that for awhile now and that's great-- "hyper-focusing" or i.e. "fixating", and the "forest through the trees" analogy. What's good for ADD is freaking TERRIBLE for OCD! (And what a b**ch it is to have both.) It IS counterproductive, ISn't it?!! i hATe it! It's like yeah i'll be able to focus better but how the !@#*^%$# do i UNfocus, or contROL the freaking focus???!
Anyway, sorry, just wanted to get that out. A prior love relationship with stimulants has become a more aware hatred for those cursed, cursed, cursed drugs. (ok well they can be helpful soemtimes, but yeah). Oh and i still love my little caffeine-- oh lovely lovely blessed caffeine.
P.S. And the fact that we are drugging millions of freaking kids on this crap (forced drugging, essentially-- oftentimes) infuriates me. Turning them into grandiose little obsessive-compulsive speed freaks before they even have a chance to realize whats going on or express it adequately or develop into maturity-- yeah that's wonderful. And no this didnt happen to me-- all my stimulant use was willful (and not nearly as much or often as many of these kids have to take), but i did so in ignorance. End shpiel.
Posted by Caleb462 on June 16, 2003, at 11:57:04
In reply to Re: Obsessively looking » BekkaH, posted by Questionmark on June 16, 2003, at 4:46:34
> First, Caleb, you said "Clomipramine is also a 5-HT2a antagonist. Thus you get multiple Anti-depressant/Anti-obsessional effects from the same drug." i thought 5-HT2 (including 5-HT2a i think) agonism helps obsessive-compulsive tendencies and 5-HT2 antagonism aggravates OC stuff. Am i wrong on this or are you (/him)? Please, i'm really curious about this.
Well... it's complex. There has been some information that 5-HT2a agonists may help OCD - because there are many ancedotal reports of LSD and other 5-HT2a/c agonists alleviating OCD symptoms. And atypical anti-psychotics have been shown to worsen OCD when used alone - without an SRI. When an SRI and a 5-HT2 blocker are combined, however, there doesn't seem to be any problem - and indeed, it seems to boost the anti-obsessional effects.
> BekkaH said:
> > "I was much more obsessive-compulsive when I was on Adderall. It was so bad that it was completely counterproductive. Some people report "hyper-focusing" on Adderall, and I noticed that as well, although I referred to it as "fixation" more than "hyper-focusing," but it's essentially the same idea. It became increasingly difficult to see the forest through the trees."
> That is SUCH a brilliant explanation of the worsening of obsessive-compulsiveness caused by stimulants. i've been trying to think how to describe that for awhile now and that's great-- "hyper-focusing" or i.e. "fixating", and the "forest through the trees" analogy. What's good for ADD is freaking TERRIBLE for OCD! (And what a b**ch it is to have both.) It IS counterproductive, ISn't it?!! i hATe it! It's like yeah i'll be able to focus better but how the !@#*^%$# do i UNfocus, or contROL the freaking focus???!
> Anyway, sorry, just wanted to get that out. A prior love relationship with stimulants has become a more aware hatred for those cursed, cursed, cursed drugs. (ok well they can be helpful soemtimes, but yeah). Oh and i still love my little caffeine-- oh lovely lovely blessed caffeine.
> P.S. And the fact that we are drugging millions of freaking kids on this crap (forced drugging, essentially-- oftentimes) infuriates me. Turning them into grandiose little obsessive-compulsive speed freaks before they even have a chance to realize whats going on or express it adequately or develop into maturity-- yeah that's wonderful. And no this didnt happen to me-- all my stimulant use was willful (and not nearly as much or often as many of these kids have to take), but i did so in ignorance. End shpiel.
Posted by avid abulia on June 16, 2003, at 14:03:47
In reply to Re: Obsessively looking, posted by Caleb462 on June 16, 2003, at 11:57:04
> > First, Caleb, you said "Clomipramine is also a 5-HT2a antagonist. Thus you get multiple Anti-depressant/Anti-obsessional effects from the same drug." i thought 5-HT2 (including 5-HT2a i think) agonism helps obsessive-compulsive tendencies and 5-HT2 antagonism aggravates OC stuff. Am i wrong on this or are you (/him)? Please, i'm really curious about this.
>
> Well... it's complex. There has been some information that 5-HT2a agonists may help OCD - because there are many ancedotal reports of LSD and other 5-HT2a/c agonists alleviating OCD symptoms. And atypical anti-psychotics have been shown to worsen OCD when used alone - without an SRI. When an SRI and a 5-HT2 blocker are combined, however, there doesn't seem to be any problem - and indeed, it seems to boost the anti-obsessional effects.
it also partially depends on your type of OCD. if you have OCD occurring in conjunction with tics or a family history of tics, 5-ht2a antagonism, along with D2 antagonism, can significantly improve symptoms without an SRI. risperdal has the most studies in this regard.>
>
> > BekkaH said:
> > > "I was much more obsessive-compulsive when I was on Adderall.although some people report feeling worse on a stimulant if they have OCD, a small subset does significantly better with stimulant augmentation... which may partially explain the efficacy of Parnate in many individuals.
~AA
Posted by jemma on June 16, 2003, at 14:30:51
In reply to Re: Obsessively looking - leeran » BekkaH, posted by leeran on June 16, 2003, at 1:08:31
Hi Leeran -
I have to agree with everyone who's said that OCD gets worse on stims. I focus much better, but sometimes find myself still focusing at 3 am, having not moved from my desk - to eat, drink, or even use the washroom - for twelve hours straight.
One thing I found useful for taking the edge of my obsessiveness was lamictal. Also, I can't imagine getting obsessive on selegiline. Although it increases dopamine, it actually lowers blood pressure by increasing nitric oxide.
It's been quite successful in treating children with ADD and Tourette's, which also gets worse with stims. I get tics and very mild OCD, and selegiline didn't trigger either.How's your dog doing? Mine has found a hidden swamp in the ravine near where we walk. Baths have become an almost nightly occurence - and he's 100 pounds and very energetic. Suffice it to say that when he's wet, so am I.
- Jemma
Posted by Sabina on June 16, 2003, at 15:36:22
In reply to Depressogenic, wimpogenic ssri's, posted by BekkaH on June 16, 2003, at 0:32:53
Yikes. Something rang a bell there that you said. Just last night, in fact, I remembering thinking, I've stopped caring that I don't care. I still have a personality (or maybe I just *think* that I do) but I can't get angry and am definitely more apathetic and lethargic. This is exactly why I always end up quitting SSRI's. I try so hard to stay positive about my treatment. My boyfriend doesn't want me to quit another one, and I agree that I need some form of chemical assistance, but I always hate the day when I wake up and realize that someone's replaced me with a seratonin zombie.
Posted by rod on June 16, 2003, at 18:33:01
In reply to Re: Depressogenic, wimpogenic ssri's, posted by Sabina on June 16, 2003, at 15:36:22
> ... I've stopped caring that I don't care. I still have a personality (or maybe I just *think* that I do) but I can't get angry ...
you name it...
Posted by ace on June 17, 2003, at 1:40:26
In reply to Re: Obsessively looking for best OCD medication » ace, posted by leeran on June 16, 2003, at 0:51:16
> Thanks so much, Ace!
>
> I have read many of your posts.
>
> Are you currently on Parnate right now? I remember you made a switch a few weeks ago.
>
> Best,
>
> LeeHey Lee!,
At the moment I'm on Nardil- it's actually doing a preety good job on the OCD - better than it was before actually.I read the title of your post and thought "How me!" I'm exactly the same- obsessive in everything- even in the meds to choose! We will always be this way but! Keep me updated on works for you- always know there is the 'good 'ol MAOIs' there if you need 'em- they really are amazing drugs! Finally, it looks as if the antidepressant response has kicked in- so glad. 5 months on it before I experienced so much happiness/motivation every day!
God Bless You, and keep searching until OCD has it's day of reckoning!
Ace, Nardil Maniac! 90mg.
Go forward in 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.