Psycho-Babble Medication Thread 247350

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Stimulants increasing anxiety, OCD? (long)

Posted by noa on August 1, 2003, at 11:35:48

This is goign to be long. I appreciate the patience involved in reading through the post, if you make it to the end! : - )

The ultimate question will be about medication, but let me describe the problem in detail first, along with other types of interventions that apply.

I have dermatillomania (skin picking) which is considered to be an OCD spectrum disorder. I believe that I have had it since childhood, but that it is exacerbated by one or more of my meds. Two of my siblings also seem to have it, although I think in a much milder form.

I have been working on trying to understand this behavior more, and am noticing that it seems to have several facets for me. It is a compulsive behavior. It also feels neurological, kind of the way my med-induced akithisia feels, including the RLS-like kicking. It *feels* tic-like and is extremely difficult to suppress, and when I can suppress it, it comes out later in the day. On the other hand, there are times, when it also feels somewhat habit-like.

There seem to be two modes of this behavior for me. The primary mode is kind of absentmindedly scratching and picking at my scalp or face. This occurs when I am passively engaged in something (driving, watching tv, etc.). Often, I might not notice I'm doing it (although since I started working on addressing this problem in earnest, I have been noticing it within a few seconds of initiating it). In this mode, it feels neurological, tic-like, compulsive, impulsive, as well as habit-like at times. In this mode, it seems driven both by what my hand needs to be doing(like a repetetive movement or tic), and what my skin needs to feel (stimulation, self-soothing, etc.). In this mode, it can also be less absentminded, as well, in that I sometimes tune into what I am doing and how it feels. It is calming and stimulating at the same time. The stimulation is similar to what I feel if I grab a large fistful of hair and gently and slowly tug, the way some massage therapists do. I have also been able to recreate this sensation by using the sensory integration technique of brushing the skin. In the passive activity mode, it feels like the picking behavior is soothing. It also feels like it is providing sensory input because I'm feeling understimulated in the passive activity, but also calming and soothing to shut out feeling overstimulated by stress, etc.

The other mode is one that has developed in recent years (I have always had the skin picking although I think it is exacerbated by meds, but before a few years ago, it involved only the first mode described above). It involves standing in front of the mirror, inspecting my facial skin and picking at pores, pimples, bumps, etc.--any imperfection. Over time, this mode has worsened. Sometimes, I spend hours doing this, lost in a trance-like state. It is highly compulsive and what I've been able to tune into lately is that there is a corresponding obsessive thought (I hadn't really been aware of the OCD quality of it before a few weeks ago): total preoccupation with getting rid of all textural imperfections on my skin. So, it definitly feels compulsive, like the first mode, only much moreso and more OCD-like compulsive. Of course, as the behavior has worsened in recent years, more time is lost to it, it has become much more dissociative-like, and my skin has worsened from the effects of picking at it. My skin often looks broken out, or rashy or hivey, and has small lesions and scabs. I have constantly been trying to stop the behavior and know that the picking makes the skin worse, but haven't been able to stop. In recent weeks, I've been able to do this less frequently, and sometimes to stop myself sooner in the process, and I have been able to be less agressive about it, so the apparent skin damage has decreased somewhat. I have been able to start challenging the prevailing compulsive thinking that somehow I am going to clear up the acne and clogged pores by this behavior. So, even when I slip and go into the mirror trance mode, when I stop, I look at myself in the mirror and ask, "is what you just did really going to help?" and of course, the rational answer is always emphatically "No". I am hoping that repeating this cognitive challenge will help.

Whether this second mode (mirror mode) is calming like the other mode, is hard to say, and it doesn't feel like it gives the same kind of sensory input/stimulation that the other mode does. In some ways, it might be calming because of the pseudo-dissociative trance-like thing that happens. BUT, the mirror mode is more agitating, really. It feels a bit neurological but less so than the first mode, with the OCD energy becoming more primary. Often, the passive mode behavior leads to the mirror mode behavior when I start picking at my face instead of my scalp--and in that mode, it feels more neurological, and tic-like, compulsive and impulsive. What happens is that I might be touching my face at that point, and then start getting preoccupied with what I feel on my face, and then go to the bathroom mirror, where the more compulsive/OCD aspect seems to become the primary driving force. The more I stand there going after the pores, etc., the more preoccupied I think I feel and the more pulled into the compulsive repetition I feel. It is similar to the agitated addictive feeling I felt playing hours of minesweeper and freecell (during which I also would go into a pseudo-dissociative trance-like state and lose hours of time) before I deleted all my computer games. Both behaviors feel addictive but unsatisfying, where I feel compelled to keep repeating it over and over and over.

Strategies I'm working on include some cognitive behavioral strategies like the cognitive self talk challenge I described above, and Habit Reversal Training, which I am just beginning to learn about. It basically involves substituting an alternative action that is incompatible with the disordered behavior. So, I bought a stress ball that I use it a lot in the car, but also at other times. It is interesting that I find that when I have the stress ball in my hand, my restless, anxious energy become much more apparent to the outside world---I get really fidgetty with the stress ball. But it feels good, not agitating. It is just that I usually hold all that energy in, except for the dermatillomania behaviors, and sometimes when I can get impulsively hyperverbal with people, and when I stop suppressing the akithisia and allow my leg-bouncing and other restless movements to come out.

So, now for the med questions. I have started reading about neurotransmitters and their effects on repetetive movements and self-grooming behaviors in animals. Mostly, the studies show that such behaviors can be induced or increased by administering dopamine agonists, although there seems to be a difference between D1 agonists and D2 agonists. My recall is shaky at the moment, but I think in one study the D1 agonists were induced the sterotypy but not the D2 agonists. At some point, I can post the references for anyone who is interested. Another study showed that wasp venom, which is similar to dopamine, induced a sustained period of ultra-repetitive grooming in a stung cockroach, followed by what seems like catatonia, and the authors created a similar effect (hyper grooming follwed by catatonia-like state) in the cockroach by administering a substance that causes the release of massive amounts of the cockroach's neurotransmitters until they are depleted.

I have also read a lot about how OCD spectrum problems and compulsive behaviors are successfully treated by SSRIs.

I have not found support for my idea that the serotonin-induced motor activation I do have could explain the dermatillomania.

I have read things that support the idea that stims incrase anxiety and OCD symptoms.

I was hoping it was the Effexor and not the Adderall, but it is looking like the stimulant may be the main problem.

I discussed this with my pdoc, who thinks it is the stim.

I need to try to stop caffeine intake and see if that helps at all. I also need to exercise more consistently. When I do, I notice the akithisia energy getting released somewhat, and I wonder if that would help with this problem.

My question is: what are your experiences with stims, anxiety and OCD? Has anyone found stims to increase OCD behaviors? I have heard this is so, but I would like to hear first person accounts from folks here at babble, and any other insights y'all might have.

If you've made it this far in your reading, I cannot thank you enough!!

 

Re: Stimulants increasing anxiety, OCD? (long) » noa

Posted by Snoozy on August 2, 2003, at 0:54:15

In reply to Stimulants increasing anxiety, OCD? (long), posted by noa on August 1, 2003, at 11:35:48

Hi noa -

I've had OCD as long as I can remember, and I've had behaviors somewhat similar to the ones you describe. One thing that started when I was a kid was absentmindedly pulling out eyelashes. I got over this as an adult because I hated looking in the mirror at those balding eyelids :) It took a while of being very conscious of when I was doing it, and I just tried to direct that energy elsewhere - you know, picking at my cuticles or something! I did realize that I've seen a family member doing this for years (still does).

Actually, I've been able to get away from anything involving the face, it's just directed someplace else. A lot of it was about hating to look in the mirror (just your run-of-the-mill self-loathing).

It sounds like you have some insights into what's going on, and the cognitive behavioral strategies and the habit reversal sound very helpful. It probably takes some time and patience, as these behaviors are like auto-pilot (in my experience).

As far as drugs, I never experienced any significant relief from the SSRI's (I have several other weird OCD things). I've wondered if medications are more helpful for some types of OCD behavior and less for others - like counters versus hand washers or something. Or maybe it's just an individual thing.

I would think serotonin-induced motor activiation (from medication?) could have an effect on the dermatillomania. When I have taken meds that have that agitating/activating quality, I find I do a lot more of those types of things, and it seems to serve a dual purpose of getting that nervous energy out, and also being soothing, as you mention. (There's the famous Prozac leg bounce).

I've been on stims for 6 weeks, and when I started I was worried because I also had read about how they can increase OCD symptoms. I haven't noticed a big effect one way or the other. I can certainly see how it would be possible. Again, maybe it's better (or worse) for some types of OCD symptoms than others. At times it has seemed like with the increased alertness/concentration from the stims, I don't do those OCD things that I tend to do when I'm really groggy/fuzzy-headed/stuporous.

My experience with anxiety and OCD is that in periods where my anxiety is really increased, the OCD is much worse.

Were you on Effexor before Adderall? I've never had akathisia (sp?), but I've heard exercise can be helpful for it.

(I've been off caffeine for a month, and I'm starting to feel a difference - in a good way, but more related to headaches )

 

Re: Stimulants increasing anxiety, OCD? (long)

Posted by noa on August 7, 2003, at 6:43:18

In reply to Re: Stimulants increasing anxiety, OCD? (long) » noa, posted by Snoozy on August 2, 2003, at 0:54:15

Hey, Snoozy--thanks for replying.

I have been off caffeine for about a week, with one exception, on an airplane. I am still picking when sitting and reading or watching tv. I haven't been driving while away from home--that is usually my other place for the absentminded picking. I've beendoing a small amount of mirror picking, but the reduction might be due to sharing living spaced with other people.

You may be right about SSRIs helping with some OCD problems but not others. But no one seems to know how to predict anything--it is all trial and error no matter what. Like Andrew Solomon ("Noonday Demon") says--it is like a game of darts, and hopefully one of the darts hits the target more or less.

Good luck--I hope the stimulants work for you without problems.

 

Re: Stimulants increasing anxiety, OCD? (long)

Posted by defre on January 9, 2008, at 17:05:18

In reply to Stimulants increasing anxiety, OCD? (long), posted by noa on August 1, 2003, at 11:35:48

I too have dermatillomania, and my symptoms are very close to yours. I suggest you visit this website about compulsive skin picking (www.skinpick.com) - it's got some useful info and managed to answer some of my private questions. I wish you well.

 

Re: Stimulants increasing anxiety, OCD? (long)

Posted by katannallee on January 20, 2008, at 3:13:13

In reply to Stimulants increasing anxiety, OCD? (long), posted by noa on August 1, 2003, at 11:35:48

RE:
> My question is: what are your experiences with stims, anxiety and OCD? Has anyone found stims to increase OCD behaviors? I have heard this is so, but I would like to hear first person accounts from folks here at babble, and any other insights y'all might have.


My experiences with face picking definitely started with stimulants and most prolonged excursions there begin while its in my system...how ever as time goes by I realize other stresses can bring it on. I am always conscious of it, but seems mostly my mind is so overloaded thoughts going on and on in many directions at once for hours on end till I'm in tears begging God to help, as usual, last time I knew everything would be okay once the stimulant was out of my system and sure enough the next day it was completely controllable.

My qiestion is why do I keep choosing to go back to this miserable waste of time?

 

Re: Stimulants increasing anxiety, OCD? (long) » noa

Posted by 4WD on January 20, 2008, at 18:40:47

In reply to Stimulants increasing anxiety, OCD? (long), posted by noa on August 1, 2003, at 11:35:48

Hi Noa,

I only have mild OCD but it is helped by SSRIs (I am on Celexa). I have to do a lot less counting, balancing things to be even, etc.

As to your other question, stimulants definitely increased OCD behaviors. I spent hours in front of the mirror picking at my face. I would spend hours tweezing hair off my legs. I would pick at my legs, my arms my skin, anywhere. This was when I was on Ionamin which is actually a diet pill, a pretty mild form of speed (but since I was abusing it, it wasn't mild at all for me - I was taking way too much of it.)

So I think it is probably the stimulant which is exacerbating the skin picking problem. I think your pdoc is right on this one.

Marsha

 

Re: Stimulants increasing anxiety, OCD? (long)

Posted by rina on January 22, 2008, at 18:12:26

In reply to Re: Stimulants increasing anxiety, OCD? (long), posted by defre on January 9, 2008, at 17:05:18

It's weird, eventhough I gave up stimulants a little while back because they affected the hormones in my brain and kidney. I recently had a episode that was caused by the adderall xr I used to take. What happen was I felt like bugs were in my body and the floor was continually moving. As a result, I cut all my hair off everywhere and became extremely paranoid for about three weeks. My doctor said this happens when detoxing from any stimulants that have been taken for a period of time, especially at a high dose and also because I refused to take anything to help me detox. Just my two cents. Good Luck!

 

Re: Stimulants increasing anxiety, OCD? (long) » noa

Posted by kingcolon on January 25, 2008, at 0:25:44

In reply to Stimulants increasing anxiety, OCD? (long), posted by noa on August 1, 2003, at 11:35:48

It's great to read your posts since I"m in the throws of picking right now. I've also noticed my scalp picking is triggered, or perhaps caused, by stimulants. The one's I've been on have been Wellbutrin, Nardil (dopaminergic), and to a lesser extent, Mirapex and Requip. I'm using buprenorphine (Subutex) now for my depression (and some history of opioid misuse). I think it too causes or exacerbates the picking, probably because it is dopaminergic. I'm also on Cymbalta, and it doesn't control it as long as I'm on stimulants or bupe too. I find I can gain control if I don't begin to pick, catching myself immediately. If I start, even a little, it's horrible to stop. I often irritate one area so much it becomes chronically inflamed. I find if I take a long hot shower and bathe the area, I feel better and may not pick for a long time after. Unfortunately, SSRI's alone are not good enough for my depression.

 

Re: Stimulants increasing anxiety, OCD? (long)

Posted by Henry Miller on June 14, 2008, at 0:19:40

In reply to Re: Stimulants increasing anxiety, OCD? (long) » noa, posted by kingcolon on January 25, 2008, at 0:25:44

I have the same skin picking problem. Try boosting your SSRI with a low-dose of Lithium. I take 150 mg of Lithobid( 300mg cut in half) twice a day. The Lithium + 50mg of Liquid Zoloft knocked my depression and OCD right of the water and significantly abated my social anxiety but not completely. I've had zero side effects on Lithium. In fact the Lithium boosts my sex drive. If low-dose Lithium, doesn't work, try Buspar. Buspar is pretty awesome stuff when augmented with an SSRI. It's really dose specific and thus requires a great deal of trial an error. It didn't start working for me until I reached 60 mg. I would still be on Buspar if my doc had encouraged Lithium and since the Lithium is about ten times more effective...I'm sticking with it for now.

As for stims, I too have a fondness for these little magic pills. Stims, particularly desoxyn, work great for my social anxiety and cognition but are horrible on my OCD. I wish there was something that could boost my brain power without turning me into an OCD nutcase that can't stop checking his MySpace page every thirty seconds.

Has anyone tried Dextroamphetamine ie. Dexedrine. I read an article on the web that claims Dex is supposed to help OCD in some cases??? It's funny b/c Desoxyn treats some of my OCD symptoms but makes others worse.

I had high hopes for Provigil but that also triggered the skin picking. Selegine (2.5 mg wafers aka Zelepar) seems to be working for now but my blood pressure has dropped drastically?


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