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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by ace on July 31, 2004, at 23:35:33
Im going to try everything under the sun with Nardil, but after that I have these in mind...
1. Luvox + Anafranil + Zyprexa
2. Luvox + Anafranil + Buspar
3. Luvox + Anafranil + Seroquel
any comments??Thanks!~
Ace
Nardil- 75
Zyprexa 5
Xanax 1-3mg
Posted by cpallen79 on August 1, 2004, at 3:16:54
In reply to Potent Anti-OCD cocktail!, posted by ace on July 31, 2004, at 23:35:33
Hi Ace... all three of those combos sound beautiful. Doublecheck on these /w chemist or Sad Panda. They may have input too.
Chris> Im going to try everything under the sun with Nardil, but after that I have these in mind...
>
> 1. Luvox + Anafranil + Zyprexa
>
> 2. Luvox + Anafranil + Buspar
>
> 3. Luvox + Anafranil + Seroquel
>
>
> any comments??
>
> Thanks!~
>
> Ace
>
> Nardil- 75
> Zyprexa 5
> Xanax 1-3mg
Posted by chemist on August 1, 2004, at 9:08:26
In reply to Re: Potent Anti-OCD cocktail! » ace, posted by cpallen79 on August 1, 2004, at 3:16:54
hey ace, i'd go with recipe #3, and if that doesn't work, #1. i personally don't hold buspar in very high regard, but that is only my experience.....as for the TCA, that's panda's department, but it looks good to me.....cheers, chemist
> Hi Ace... all three of those combos sound beautiful. Doublecheck on these /w chemist or Sad Panda. They may have input too.
> Chris
>
> > Im going to try everything under the sun with Nardil, but after that I have these in mind...
> >
> > 1. Luvox + Anafranil + Zyprexa
> >
> > 2. Luvox + Anafranil + Buspar
> >
> > 3. Luvox + Anafranil + Seroquel
> >
> >
> > any comments??
> >
> > Thanks!~
> >
> > Ace
> >
> > Nardil- 75
> > Zyprexa 5
> > Xanax 1-3mg
>
>
Posted by Sad Panda on August 1, 2004, at 10:32:10
In reply to Re: Potent Anti-OCD cocktail! » cpallen79, posted by chemist on August 1, 2004, at 9:08:26
> hey ace, i'd go with recipe #3, and if that doesn't work, #1. i personally don't hold buspar in very high regard, but that is only my experience.....as for the TCA, that's panda's department, but it looks good to me.....cheers, chemist
>
>
> > Hi Ace... all three of those combos sound beautiful. Doublecheck on these /w chemist or Sad Panda. They may have input too.
> > Chris
> >
> > > Im going to try everything under the sun with Nardil, but after that I have these in mind...
> > >
> > > 1. Luvox + Anafranil + Zyprexa
> > >
> > > 2. Luvox + Anafranil + Buspar
> > >
> > > 3. Luvox + Anafranil + Seroquel
> > >
> > >
> > > any comments??
> > >
> > > Thanks!~
> > >
> > > Ace
> > >
> > > Nardil- 75
> > > Zyprexa 5
> > > Xanax 1-3mg
> >
> >
>Luvox + Anafranil sounds like a recipe for disaster to me. :) Combining two therapeutic dosages of two different SRI's will cause just as much serotonin syndrome as adding either to Nardil.
Why not try something sensible such as Anafranil + Xanax or Luvox + Zyprexa? Also, you need to stop thinking too much about your meds because dreaming about the next drug cocktail to try is a sure fire way of ensuring that the current cocktail is a failure given that probably half of a drugs effect is placebo. Don't disregard CBT either, Drugs + CBT is better than either alone & that is an actual fact.
Cheers,
Panda.
Posted by RetiredYoung on August 1, 2004, at 10:54:36
In reply to Re: Potent Anti-OCD cocktail!, posted by Sad Panda on August 1, 2004, at 10:32:10
I've just been posting in a current thread about taking Luvox along with a TCA for depression - the key for me is that the SSRI would be at a low-end therapeutic dose, while the clomipramine (or imipramine or nortriptyline) would be at low or mid-level dosages. Some info I've read lumps clomipramine along with all the other TCAs, while Panda (perhaps, very quite rightly) singles out clomipramine as being exceedingly serotonergic.
I personally believe that Luvox being labelled as OCD-only in the U.S. is just a marketing thing; any SSRI would have a good chance of working for OCD and/or depression.
Also, atypical antipsychotics scare me. I've read too many posts about anti-ap induced TD. IMHO, I'd try a route that left those out, at least at first.
I've had a lot of success with Buspar in the past mixed with Effexor. However, the Effexor seemed to cause me to take the Buspar. The moral here is that you may want to consider slowing down the cocktail aspect of your plan. For example, start with Luvox, then make a decision as to what you need next (if anything) based on your reaction. After that, you could then re-evaluate and either drop or append anothe medication.
Best of luck to you...
Posted by chemist on August 1, 2004, at 12:55:58
In reply to Re: Potent Anti-OCD cocktail!, posted by Sad Panda on August 1, 2004, at 10:32:10
ace, panda, all else....a hardy ``oops'' from me.....thanks for the reality check, do listen to panda! all the best, chemist
> > hey ace, i'd go with recipe #3, and if that doesn't work, #1. i personally don't hold buspar in very high regard, but that is only my experience.....as for the TCA, that's panda's department, but it looks good to me.....cheers, chemist
> >
> >
> > > Hi Ace... all three of those combos sound beautiful. Doublecheck on these /w chemist or Sad Panda. They may have input too.
> > > Chris
> > >
> > > > Im going to try everything under the sun with Nardil, but after that I have these in mind...
> > > >
> > > > 1. Luvox + Anafranil + Zyprexa
> > > >
> > > > 2. Luvox + Anafranil + Buspar
> > > >
> > > > 3. Luvox + Anafranil + Seroquel
> > > >
> > > >
> > > > any comments??
> > > >
> > > > Thanks!~
> > > >
> > > > Ace
> > > >
> > > > Nardil- 75
> > > > Zyprexa 5
> > > > Xanax 1-3mg
> > >
> > >
> >
>
> Luvox + Anafranil sounds like a recipe for disaster to me. :) Combining two therapeutic dosages of two different SRI's will cause just as much serotonin syndrome as adding either to Nardil.
>
> Why not try something sensible such as Anafranil + Xanax or Luvox + Zyprexa? Also, you need to stop thinking too much about your meds because dreaming about the next drug cocktail to try is a sure fire way of ensuring that the current cocktail is a failure given that probably half of a drugs effect is placebo. Don't disregard CBT either, Drugs + CBT is better than either alone & that is an actual fact.
>
> Cheers,
> Panda.
>
Posted by linkadge on August 1, 2004, at 13:42:37
In reply to Re: Potent Anti-OCD cocktail!, posted by RetiredYoung on August 1, 2004, at 10:54:36
I'm the same way ace. I just keep dreaming that the next drug will make all my problems seem simple and my worries nonexistant.
But we were meant to feel some degree of pain in this life. Cause quite frankly if it didn't hurt sometimes, most people wouldn't give a care. Pain is sometimes necessary for us to make changes that we don't want to make.
Count your blessings. Sometimes I think that what I have is abnormal, then I just ask people around me and find out that 99% of people are thinking the same way as I am.Sometimes you say that your OCD is like 80% cured. Then you're pretty darn lucky.
Don't mean to be such a downer
Linkadge
Posted by ace on August 1, 2004, at 21:28:54
In reply to Re: Potent Anti-OCD cocktail!, posted by Sad Panda on August 1, 2004, at 10:32:10
> > hey ace, i'd go with recipe #3, and if that doesn't work, #1. i personally don't hold buspar in very high regard, but that is only my experience.....as for the TCA, that's panda's department, but it looks good to me.....cheers, chemist
> >
> >
> > > Hi Ace... all three of those combos sound beautiful. Doublecheck on these /w chemist or Sad Panda. They may have input too.
> > > Chris
> > >
> > > > Im going to try everything under the sun with Nardil, but after that I have these in mind...
> > > >
> > > > 1. Luvox + Anafranil + Zyprexa
> > > >
> > > > 2. Luvox + Anafranil + Buspar
> > > >
> > > > 3. Luvox + Anafranil + Seroquel
> > > >
> > > >
> > > > any comments??
> > > >
> > > > Thanks!~
> > > >
> > > > Ace
> > > >
> > > > Nardil- 75
> > > > Zyprexa 5
> > > > Xanax 1-3mg
> > >
> > >
> >
>
> Luvox + Anafranil sounds like a recipe for disaster to me. :) Combining two therapeutic dosages of two different SRI's will cause just as much serotonin syndrome as adding either to
Nardil.I have to beg to differ. I have seen many on an SSRI combination and Anafranil.
My sister is currently on 60mg Prozac and 25mg Anafranil.
A small dose of Anafranil- 25-75mg added to an SSRI is fine, IMO.
>
> Why not try something sensible such as Anafranil + Xanax or Luvox + Zyprexa?Maybe at first yes.
Also, you need to stop thinking too much about your meds because dreaming about the next drug cocktail to try is a sure fire way of ensuring that the current cocktail is a failure given that probably half of a drugs effect is placebo.
I disagree again. I, in conrast to many scholars, believe the placebo effect is weak.
I have reduced my thinking/analysing my meds as of late, but like I've said before- I'M never going to stop until I get 100% remmission- and THIS IS possible.
Don't disregard CBT either, Drugs + CBT is better than either alone & that is an actual fact.
2 years of CBT unequivocally made my OCD, depression and anxiety worse. No more CBT ever again.
> Cheers,
> Panda.
>
Posted by Sad Panda on August 2, 2004, at 2:23:26
In reply to Re: Potent Anti-OCD cocktail! » Sad Panda, posted by ace on August 1, 2004, at 21:28:54
> >
> > Luvox + Anafranil sounds like a recipe for disaster to me. :) Combining two therapeutic dosages of two different SRI's will cause just as much serotonin syndrome as adding either to
> Nardil.
>
> I have to beg to differ. I have seen many on an SSRI combination and Anafranil.
>
> My sister is currently on 60mg Prozac and 25mg Anafranil.
>
> A small dose of Anafranil- 25-75mg added to an SSRI is fine, IMO.
>
>Your sisters doseage of 25mg is a long way short of an actual therapeutic dose. Try it in the 150-250mg range.
>
>
> I'M never going to stop until I get 100% remmission- and THIS IS possible.
>
>Not possible or practical. Some obsessive behaviour is normal & required.
Cheers,
Panda.
Posted by zeugma on August 2, 2004, at 5:58:42
In reply to Anafrail at a Therapeutic dose. » ace, posted by Sad Panda on August 2, 2004, at 2:23:26
Hi
I don't know if 100% improvement is possible or practical for a number of reasons.
First, the more complicated the cocktail the more types of interaction become possible. I would even include talk therapy in this, because CBT was added to my regime in the attempt to mitigate my debilitating social phobia. I worked hard at my exercises, but found the overall effect to be anxiogenic to the point where I seriously considered hopitalization. Also, there was an 'interaction' between CBT and my med regime because my psychiatrist was confident that CBT would lower my anxiety, and hence maintained me on my medications despite evidence of worsening anxiety. It was only when CBT was terminated, on my own initiative, becuse it was obvious that things were getting out of hand, that I was prescribed an anxiolytic, which resulted in immediate improvement.
This is not to say that CBT wouldn't work for you. From my (casual) perusal of the data, CBT has more effectiveness in OCD than in severe social phobia. There are other therapeutic options that may work better. I don't know. I've experimented with different 'dosages' (i.e. frequency) of talk therapy. The problem I have found (and this may or may not be applicable to you) is that as improvements occur in one part of life, this can cause other problems to come to the fore. When I was literally too depressed to eat or sleep, my main goal was to stabilize my weight and sleep pattern. I felt (rightly) that my career would only move forward when I got these problems under control. Now that I am no longer anorexic and insomniac, I have other issues to deal with, such as finding an effective treatment for my ADD and avoidant personality disorder, which cause tremendous unhappiness. Unfortunately, the most effective treatments for ADD cause anorexia and insomnia for me, which in turn induce further depression. The drugs counteract each other, in other words, even if this is not a pharmacodynamic effect.
To conclude by echoing what others have said, no one goes through life with no symptoms of anything whatsoever. I have found it necessary to be patient and realistic when using these various modalities to get my symptoms under control.
Posted by linkadge on August 2, 2004, at 13:59:54
In reply to Re: Anafrail at a Therapeutic dose., posted by zeugma on August 2, 2004, at 5:58:42
Trying to achieve 100% freedom from any mental state is indeed impossible. Mental illness is not binary. Everybody gets a little down now and again. Everybody gets obsessive now and again. Many people even get a little paranoid from time to time.
Trying to eliminate a certain human condition 100% is impossible. OCD'rs are trying to achieve perfection in everything. It is very common for OCD'rs to obsess about their medications.
One would never say that because they've failed one type of medication that all will fail. In the same way, their are innumerous types of therapy and just because you failed one type does not mean all will fail.
When doctors say someone is in remission from depression, this means that 60% or more of their symptoms are handeled. I agree with panda that to be 100% free of obsessivness is not human, and it is literally distructive to expect this. This is where therapy fills in the blanks. What to do when medications fail, or don't meet our expectations.
Linkadge
Posted by don_bristol on August 2, 2004, at 14:32:39
In reply to Re: Potent Anti-OCD cocktail!, posted by Sad Panda on August 1, 2004, at 10:32:10
>> Luvox + Anafranil sounds like a recipe for disaster to me. :) Combining two therapeutic dosages of two different SRI's will cause just as much serotonin syndrome as adding either to Nardil.
Why not try something sensible such as Anafranil + Xanax or Luvox + Zyprexa? Also, you need to stop thinking too much about your meds because dreaming about the next drug cocktail to try is a sure fire way of ensuring that the current cocktail is a failure given that probably half of a drugs effect is placebo. Don't disregard CBT either, Drugs + CBT is better than either alone & that is an actual fact. <<
=====
I agree with everything Panda has written.
Also note that mixing Anafranil with an SSRI *can* be done but it needs to be done very carefully. I would not risk it because of the possibility of serotonin syndrome. ISTR the anafranil is added *slowly* after the SSRI max dose has been established (and is not producing any therapeutic effects).
Nardil and/or Remeron (mentioned in your other post) have little proven value for OCD.
If you didn't find CBT worked then find another practitioner to try it with. CBT is very good. Worls as well as meds for OCD and has no side effects.
Make sure you visit http://groups.yahoo.com/group/OCD-Support/. It is the #1 forum for OCD. (You need to join).
Posted by ace on August 2, 2004, at 18:32:09
In reply to Anafrail at a Therapeutic dose. » ace, posted by Sad Panda on August 2, 2004, at 2:23:26
> >
> > I'M never going to stop until I get 100% remmission- and THIS IS possible.
> >
> >
>
> Not possible or practical. Some obsessive behaviour is normal & required.
>
> Cheers,
> Panda.
When it is ego-dystonic, it is 100% pathological.Maybe we are battling with semantics here.
If you would have substituted "fanatical" behaviour into "obsessive" behaviour, I would agree.
Posted by zeugma on August 2, 2004, at 19:57:56
In reply to Re: Anafrail at a Therapeutic dose. » Sad Panda, posted by ace on August 2, 2004, at 18:32:09
>
> > >
> > > I'M never going to stop until I get 100% remmission- and THIS IS possible.
> > >
> > >
> >
> > Not possible or practical. Some obsessive behaviour is normal & required.
> >
> > Cheers,
> > Panda.
>
>
> When it is ego-dystonic, it is 100% pathological.
>
> Maybe we are battling with semantics here.
>
> If you would have substituted "fanatical" behaviour into "obsessive" behaviour, I would agree.
Semantically speaking, I would object to fanaticism far more than obsessiveness. I would describe a terrorist or KKK member as fanatical rather than obsessed.In any case, someone mentioned that SRI's are more potent anti-obsessionals than Nardil and the skimpy text i read the other day supported that. on the other hand SRI's are less potent antidepressants. Would you say your depression or your obsessions are primary?
Posted by zeugma on August 2, 2004, at 21:55:42
In reply to Re: Anafrail at a Therapeutic dose., posted by zeugma on August 2, 2004, at 19:57:56
I should have said, SRI's are generally less potent AD's than MAOI's with the exception of clomipramine, which according to many is both the most potent AD and the most potent anti-obsessional.
Posted by Sad Panda on August 2, 2004, at 22:41:14
In reply to correction., posted by zeugma on August 2, 2004, at 21:55:42
> I should have said, SRI's are generally less potent AD's than MAOI's with the exception of clomipramine, which according to many is both the most potent AD and the most potent anti-obsessional.
>
>Clomipramine is a powerful NE reuptake inhibitor too, equal to Imipramine & Amitriptyline. These three are better in monotherapy than the SSRI's becuase the increase two amines instead of just one.
Cheers,
Panda.
Posted by don_bristol on August 3, 2004, at 7:17:33
In reply to Re: Anafrail at a Therapeutic dose. » Sad Panda, posted by ace on August 2, 2004, at 18:32:09
>
> > >
> > > I'M never going to stop until I get 100% remmission- and THIS IS possible.
> > >
> > >
> >
> > Not possible or practical. Some obsessive behaviour is normal & required.
> >
> > Cheers,
> > Panda.
>
>
> When it is ego-dystonic, it is 100% pathological.
>
> Maybe we are battling with semantics here.
>
> If you would have substituted "fanatical" behaviour into "obsessive" behaviour, I would agree.=====
Hello there Ace, it's Don here. I have been following your thread.
Permit me to say that I think the semantics question which you raise is worth applying to your own statement above. Heh!
OCD is usually ego-dystonic and the related (but different) OCPD is usually ego-syntonic. Either way it makes little difference to either condition whether it is ego-dystonic or ego-syntonic when it comes to deciding if it is an illness ("pathological")
The above is true UNLESS you mean "physically caused" by "pathological". This might be in contrast to "psychologically caused". But again it makes not difference to the value of therapy in the case of either OCD or OCPD.
Hope this helps.
Don
Posted by zeugma on August 3, 2004, at 17:12:04
In reply to Re: correction. » zeugma, posted by Sad Panda on August 2, 2004, at 22:41:14
> > I should have said, SRI's are generally less potent AD's than MAOI's with the exception of clomipramine, which according to many is both the most potent AD and the most potent anti-obsessional.
> >
> >
>
> Clomipramine is a powerful NE reuptake inhibitor too, equal to Imipramine & Amitriptyline. These three are better in monotherapy than the SSRI's becuase the increase two amines instead of just one.
>
> Cheers,
> Panda.
>
Hi Panda,What's interesting is that while these three are probably the most potent AD's overall (for what that's worth, 'antidepressant' is a term that seems both too restrictive ,<i.e. caffeine reduces suicide risk, so it must be elevating mood somehow> and too loose <what makes trazodone an antidepressant and Xanax not? Apologies to anyone who got better on trazodone alone, but is there anyone in existence who has taken the 600 or so mg a day required to get full AD effect?>), imipramine and amitriptyline are useless in various forms of OCD, social phobia, and other such disorders, while CMI has efficacy at least equal to the best of the SSRI's in this respect. AMI and IMI are SRI's, but apparently they're just potent enough to deal with depression, and not deal with these other problems.
It's all mysterious to me. Desipramine is anxiogenic, and yet it is a proven antipanic agent. And I used to consider panic disorder the paradigm of an 'anxiety-spectrum' disorder.
-z
Posted by ace on August 3, 2004, at 20:20:15
In reply to Re: Anafrail at a Therapeutic dose., posted by zeugma on August 2, 2004, at 19:57:56
> >
> > > >
> > > > I'M never going to stop until I get 100% remmission- and THIS IS possible.
> > > >
> > > >
> > >
> > > Not possible or practical. Some obsessive behaviour is normal & required.
> > >
> > > Cheers,
> > > Panda.
> >
> >
> > When it is ego-dystonic, it is 100% pathological.
> >
> > Maybe we are battling with semantics here.
> >
> > If you would have substituted "fanatical" behaviour into "obsessive" behaviour, I would agree.
>
>
> Semantically speaking, I would object to fanaticism far more than obsessiveness. I would describe a terrorist or KKK member as fanatical rather than obsessed.
>
> In any case, someone mentioned that SRI's are more potent anti-obsessionals than Nardil and the skimpy text i read the other day supported that. on the other hand SRI's are less potent antidepressants. Would you say your depression or your obsessions are primary?
>Obsessions, but lately there has been some breakthrough depression....
i think i might have to go to anafranil, althought at first it causes me paradoxical depression...
Cheers!
ace
Posted by Sad Panda on August 4, 2004, at 2:04:10
In reply to Re: correction. » Sad Panda, posted by zeugma on August 3, 2004, at 17:12:04
>
> It's all mysterious to me. Desipramine is anxiogenic, and yet it is a proven antipanic agent. And I used to consider panic disorder the paradigm of an 'anxiety-spectrum' disorder.
>
> -z
>Hi Z,
Desipramine's alpha NE antagonism possible blocks panic reaction like Beta Blockers do.
Cheers,
Panda.
Posted by zeugma on August 4, 2004, at 7:57:23
In reply to Re: Anafrail at a Therapeutic dose. » zeugma, posted by ace on August 3, 2004, at 20:20:15
Hi Ace,
The TCA's can be a rough ride at first. (Actually, aren't all AD's?) A benzodiazepine should help with the initial anxiety they can trigger. A few months ago I was desperate to go on Anafranil. But I'm trying to get my ADD and energy level under control, and right now the depression's OK.
Good luck with whatever you try,
z
This is the end of the thread.
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