![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by g_g_g_unit on November 28, 2011, at 4:02:02
The stress and anxiety from trying to fight OCD is driving me crazy .. pretty much feel like I'm living day-to-day at this point. I think the Zyprexa is also making things a lot worse. I really just feel like I need some peace and quiet so I can think straight for 5 minutes.
My psych tried me on Xanax 0.25mg which felt like sugar water, but for some reason he never offered to try a higher dose. Plus, there was the whole non-fatal overdose thing a month back now, so I donno if he'd trust me. My main concern is just the fact that I'm quite prone to behavioural addiction/compulsion, but I thought that could maybe be solved with a long-acting benzo?
Posted by tensor on November 28, 2011, at 9:31:49
In reply to thinking about a benzo, posted by g_g_g_unit on November 28, 2011, at 4:02:02
> The stress and anxiety from trying to fight OCD is driving me crazy .. pretty much feel like I'm living day-to-day at this point. I think the Zyprexa is also making things a lot worse. I really just feel like I need some peace and quiet so I can think straight for 5 minutes.
>
> My psych tried me on Xanax 0.25mg which felt like sugar water, but for some reason he never offered to try a higher dose. Plus, there was the whole non-fatal overdose thing a month back now, so I donno if he'd trust me. My main concern is just the fact that I'm quite prone to behavioural addiction/compulsion, but I thought that could maybe be solved with a long-acting benzo?For me, clonazepam does not produce euphoria and as such perhaps is less abusable, maybe a better choice for you?
Posted by Phillipa on November 28, 2011, at 9:47:42
In reply to Re: thinking about a benzo » g_g_g_unit, posted by tensor on November 28, 2011, at 9:31:49
Or maybe valium. From what is written pretty mild. Phillipa
Posted by jono_in_adelaide on November 28, 2011, at 16:26:47
In reply to Re: thinking about a benzo, posted by Phillipa on November 28, 2011, at 9:47:42
I'd ask for a trial of Valium, say 5mg 2-3 times a day for a couple of weeks...... that should give you some breathing space, without risking addiction/dependance/habituation/whateveryouwanttocallit
Posted by Christ_empowered on November 28, 2011, at 21:07:58
In reply to Re: thinking about a benzo, posted by jono_in_adelaide on November 28, 2011, at 16:26:47
Klonopin is easy to take--1 tab of whatever strength, 2x daily. Can cause depression. Tapers kind of suck because its so potent that each little cut in dosage is actually significant. Shrinks love it. Its not good PRN because it takes forever to kick in.
Valium is good, but docs in the US seem to be wary of it, at least some of them. Ativan is good PRN but probably not the best for daylong sedation all the time. Xanax now comes in xanax xr, which seems like a good option but it doesn't seem too popular. I don't know what's up with that.
Posted by floatingbridge on November 28, 2011, at 22:46:08
In reply to thinking about a benzo, posted by g_g_g_unit on November 28, 2011, at 4:02:02
ggg, idk. I would love to lose my Xanax. I can't by myself at this point. I am dependent. I don't like that. I guess that's all I have to say. Maybe I need these benzos to live a semi-normal life and should drum up some kind of gratitude. But like I said, idk. So I can't advocate. I'd like to know what one would really get out of starting up. Would it help OCD symptoms and how so. Then take a calculated chance. I imagine I am being the heavy here. Sorry, ggg. You do what you and your doc think best. Does anyone else have OCD here that is weighing in? If so, how does a benzo help control your symptoms?
Posted by g_g_g_unit on November 28, 2011, at 22:56:23
In reply to Re: thinking about a benzo » g_g_g_unit, posted by floatingbridge on November 28, 2011, at 22:46:08
My concern w/ addiction doesn't necessarily derive from a drug's euphoric properties. It's the repetitive action of taking the med itself and the associated anxiety-relief it brings, which can turn compulsive for me. I've noticed this with Dexedrine - even though the euphoria is minimal, I find it quite 'soothing' and have actually been self-medicating with it on certain days when my anxiety has been particularly intense. What starts to happen is that, on days I'm taking the drug (I don't experience any cravings otherwise), I'll panic during the withdrawal and find it hard to face fear-provoking situations without it. I suppose it's a psychological dependence. So a once-a-day-med like Lorazepam or Klonopin would probably be ideal.
My pdoc suggested I reduce the Zyprexa to 5mg to see if that improves things. He also wants to possibly switch out Lexapro for an MAOI at some point in the near-future.
Posted by floatingbridge on November 28, 2011, at 23:47:16
In reply to Re: thinking about a benzo » g_g_g_unit, posted by floatingbridge on November 28, 2011, at 22:46:08
Interesting. I don't like the physical dependence that has emerged. If I don't take my vitamin x, I will get weird and given long enough, panic. Sometimes I get in a little hot water because I forget....
Posted by jono_in_adelaide on November 29, 2011, at 16:33:17
In reply to Re: thinking about a benzo, posted by g_g_g_unit on November 28, 2011, at 22:56:23
Taking 10mg of diazepam at bedtime can help prevent the syndrome you describe, where you take a pill and feel better, and get ciinstant reinforcement of the nend for pills - taken at bedtime, diazepam excerts an effect for 24 hours, so you feel calm all the next day, without that feeling of a need for another pill etc. Taken in a single dose it can take a coupl of days to sart working fully (levels in the body need to stabalise)
Ask your doc for 5mg dizaepam tabs x 50 and take 2 at bedtime. When you have 3 or 4 pills left, reduce it to one at bedtime.
Posted by Phillipa on November 29, 2011, at 18:19:41
In reply to Re: thinking about a benzo, posted by jono_in_adelaide on November 29, 2011, at 16:33:17
I take them for OCD as an anxiety disorder. Antidepressants just don't do it for me. I am more addicted to luvox than the benzos strange huh? Sounds like your OCD is different from mine though as I have more rituals than compulsions? I didn't know an MAOI was good for OCD or stimulants? Phillipa
Posted by Phidippus on November 30, 2011, at 20:53:49
In reply to thinking about a benzo, posted by g_g_g_unit on November 28, 2011, at 4:02:02
You're still on that low dose of Lexapro aren't you? I'm telling you, you need to raise that.
A benzo might reduce your anxiety, but it won't treat the OCD. Try Lyrica or Zonisamide instead. Both are glutamate antagonists and will directly treat the OCD.
Zyprexa is not going to help you at all. Its just going to make things worse.
Sorry you're having so much trouble with the OCD, but you seem stubborn about not making the right changes.
Eric
Posted by g_g_g_unit on November 30, 2011, at 22:59:29
In reply to Re: thinking about a benzo » g_g_g_unit, posted by Phidippus on November 30, 2011, at 20:53:49
I'm not being stubborn; I'm following my psychiatrist's orders. I seem to be bizarrely sensitive to medication (I get all sorts of weird movement sfx. on SSRIs), which is why he's been hesitant to ramp up the Lexapro too quickly.
So Zyprexa will make OCD worse without an adequate SSRI dose? Just need to check up on that 'cos I've been feeling like I'm losing my mind these past few days spent on a higher dose.
> You're still on that low dose of Lexapro aren't you? I'm telling you, you need to raise that.
>
> A benzo might reduce your anxiety, but it won't treat the OCD. Try Lyrica or Zonisamide instead. Both are glutamate antagonists and will directly treat the OCD.
>
> Zyprexa is not going to help you at all. Its just going to make things worse.
>
> Sorry you're having so much trouble with the OCD, but you seem stubborn about not making the right changes.
>
> Eric
Posted by SLS on December 1, 2011, at 7:19:43
In reply to Re: thinking about a benzo » Phidippus, posted by g_g_g_unit on November 30, 2011, at 22:59:29
> Try Lyrica or Zonisamide instead. Both are glutamate antagonists and will directly treat the OCD.
I didn't know that. Is this a recent finding?
- Scott
Posted by SLS on December 1, 2011, at 7:21:30
In reply to Re: thinking about a benzo » g_g_g_unit, posted by Phidippus on November 30, 2011, at 20:53:49
Posted by SLS on December 1, 2011, at 7:23:13
In reply to Re: thinking about a benzo » g_g_g_unit, posted by Phidippus on November 30, 2011, at 20:53:49
Hi Eric.
What is the status of memantine (Namenda) in the treatment of OCD?
- Scott
Posted by g_g_g_unit on December 1, 2011, at 20:09:04
In reply to Re: thinking about a benzo » Phidippus, posted by SLS on December 1, 2011, at 7:23:13
My psych ditched the Zyprexa, increased the Lexapro to 20mg and gave me valium as a stop-gap until I'm stabilized.
Posted by Phillipa on December 1, 2011, at 20:30:06
In reply to Re: thinking about a benzo, posted by g_g_g_unit on December 1, 2011, at 20:09:04
ggg let me know how the lexapro goes as take only 2.5mg of it now with 50mg of luvox and l0mg valium, .25mg xanax. Phillipa and good luck!!!! Straight taper over on meds?
Posted by g_g_g_unit on December 1, 2011, at 20:44:20
In reply to Re: thinking about a benzo » Phidippus, posted by SLS on December 1, 2011, at 7:23:13
Scott, do you think Parnate is a bad treatment choice for anxiety?
Posted by g_g_g_unit on December 1, 2011, at 20:44:53
In reply to Re: thinking about a benzo » g_g_g_unit, posted by Phillipa on December 1, 2011, at 20:30:06
> ggg let me know how the lexapro goes as take only 2.5mg of it now with 50mg of luvox and l0mg valium, .25mg xanax. Phillipa and good luck!!!! Straight taper over on meds?
Will do. Yes, straight taper.
Posted by SLS on December 1, 2011, at 21:12:04
In reply to Re: thinking about a benzo » SLS, posted by g_g_g_unit on December 1, 2011, at 20:44:20
> Scott, do you think Parnate is a bad treatment choice for anxiety?
Nardil is the MAOI most studied for anxiety disorders, and demonstrates efficacy. I would just note that Parnate was reported by Liebowitz et al. to be as effective as Nardil for treating social phobia. My guess is that the stimulant-like properties of Parnate might complicate things for some people. If you exclude Nardil from consideration, I don't think Parnate would be a bad choice.
- Scott
--------------------------------------
Also:http://www.ncbi.nlm.nih.gov/pubmed/20036427
Psychiatry Res. 2010 Feb 28;175(3):260-5. Epub 2009 Dec 29.
Double-blind comparison of 30 and 60 mg tranylcypromine daily in patients with panic disorder comorbid with social anxiety disorder.
Nardi AE, Lopes FL, Valença AM, Freire RC, Nascimento I, Veras AB, Mezzasalma MA, de-Melo-Neto VL, Soares-Filho GL, King AL, Grivet LO, Rassi A, Versiani M.
Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, R Visconde de Piraja, 407/702 Rio de Janeiro, Brazil. antonionardi@terra.com.br
Abstract
Our objective was to explore the dose-response relationship in patients with panic disorder and social anxiety disorder comorbidity (DSM-IV). After 1 week of no-drug washout, 36 such patients were assigned to a double-blind controlled comparison of the effects of 30 mg and 60 mg of tranylcypromine, and were followed up for 12 weeks. The main instrument used to measure the number of panic attacks was the Sheehan Panic and Anticipatory Anxiety Scale. The primary outcome measure for social anxiety disorder symptoms was the mean change from baseline in the Liebowitz Social Anxiety Scale (LSAS). After 12 weeks of treatment, panic attacks were reduced 69.6% from baseline in the 30-mg group (n=19) compared with a 74.8% reduction in the 60-mg group (n=17). Twelve patients (70.6%) of the higher dose group and 14 patients (68.4%) of the lower dose were completely free of panic attacks. There was no difference in efficacy between the tranylcypromine groups in the panic disorder symptoms. The 60-mg dose was more efficacious as measured by the LSAS scores, showing a significant difference in relation to the lower group. Mean change from baseline in LSAS total score (mean+/-SD) for 30-mg group was 17.9+/-14.7 and for the 60-mg group was 35.0+/-14.8. The social anxiety symptom scale showed a two-fold greater change with the 60-mg dose, and the 30-mg dose group could be considered the equivalent of a placebo control group. Tranylcypromine--60 mg daily--was found effective in the treatment of panic disorder and social anxiety disorder comorbidity.
2008 Elsevier Ltd. All rights reserved.
PMID:
20036427
[PubMed - indexed for MEDLINE]
Posted by g_g_g_unit on December 1, 2011, at 21:49:33
In reply to Re: thinking about a benzo » g_g_g_unit, posted by SLS on December 1, 2011, at 21:12:04
I've actually been on both, albeit for rather limited amounts of time. I recall lower doses of Parnate (i.e. 10-20mg) improving my attention, which would be consistent with a stimulant effect, but also being somewhat abrasive and anxiogenic. Higher doses (i.e. 40mg) seemed more anxiolytic, but the insomnia was a pain.
Given that I suffer from comorbid ADHD, I was more interested in revisiting Parnate if Lexapro at a higher dose doesn't work out.
> > Scott, do you think Parnate is a bad treatment choice for anxiety?
>
> Nardil is the MAOI most studied for anxiety disorders, and demonstrates efficacy. I would just note that Parnate was reported by Liebowitz et al. to be as effective as Nardil for treating social phobia. My guess is that the stimulant-like properties of Parnate might complicate things for some people. If you exclude Nardil from consideration, I don't think Parnate would be a bad choice.
>
>
> - Scott
>
>
> --------------------------------------
>
>
> Also:
>
> http://www.ncbi.nlm.nih.gov/pubmed/20036427
>
> Psychiatry Res. 2010 Feb 28;175(3):260-5. Epub 2009 Dec 29.
>
> Double-blind comparison of 30 and 60 mg tranylcypromine daily in patients with panic disorder comorbid with social anxiety disorder.
>
> Nardi AE, Lopes FL, Valença AM, Freire RC, Nascimento I, Veras AB, Mezzasalma MA, de-Melo-Neto VL, Soares-Filho GL, King AL, Grivet LO, Rassi A, Versiani M.
>
> Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, R Visconde de Piraja, 407/702 Rio de Janeiro, Brazil. antonionardi@terra.com.br
>
> Abstract
>
> Our objective was to explore the dose-response relationship in patients with panic disorder and social anxiety disorder comorbidity (DSM-IV). After 1 week of no-drug washout, 36 such patients were assigned to a double-blind controlled comparison of the effects of 30 mg and 60 mg of tranylcypromine, and were followed up for 12 weeks. The main instrument used to measure the number of panic attacks was the Sheehan Panic and Anticipatory Anxiety Scale. The primary outcome measure for social anxiety disorder symptoms was the mean change from baseline in the Liebowitz Social Anxiety Scale (LSAS). After 12 weeks of treatment, panic attacks were reduced 69.6% from baseline in the 30-mg group (n=19) compared with a 74.8% reduction in the 60-mg group (n=17). Twelve patients (70.6%) of the higher dose group and 14 patients (68.4%) of the lower dose were completely free of panic attacks. There was no difference in efficacy between the tranylcypromine groups in the panic disorder symptoms. The 60-mg dose was more efficacious as measured by the LSAS scores, showing a significant difference in relation to the lower group. Mean change from baseline in LSAS total score (mean+/-SD) for 30-mg group was 17.9+/-14.7 and for the 60-mg group was 35.0+/-14.8. The social anxiety symptom scale showed a two-fold greater change with the 60-mg dose, and the 30-mg dose group could be considered the equivalent of a placebo control group. Tranylcypromine--60 mg daily--was found effective in the treatment of panic disorder and social anxiety disorder comorbidity.
>
> 2008 Elsevier Ltd. All rights reserved.
>
> PMID:
> 20036427
> [PubMed - indexed for MEDLINE]
Posted by Phidippus on December 1, 2011, at 23:02:00
In reply to Re: thinking about a benzo, posted by g_g_g_unit on December 1, 2011, at 20:09:04
Bravo! Just need to keep going up on the Lexapro :) Valium is a good choice.
Eric
Posted by Phidippus on December 1, 2011, at 23:08:37
In reply to Re: thinking about a benzo » Phidippus, posted by SLS on December 1, 2011, at 7:23:13
Scott,
Namenda has quite a few studies piling up showing its efficacy as a treatment for OCD, either on its own or as an augmentation to other medications.
The key seems to be Namenda's NMDA antagonism, but it does a couple of other things which prove to have anti-OCD effect.
I'm taking 20 mg of it myself and really seems to smooth things out as well as boost mood.
Eric
Posted by Phidippus on December 1, 2011, at 23:39:12
In reply to Re: thinking about a benzo » g_g_g_unit, posted by SLS on December 1, 2011, at 7:19:43
A handful of case studies have shown Lyrica's efficacy in treating OCD. It is a glutamate antagonist and antagonizes Substance P, which seems to be implicated in the OCD circuit. Its GABA-ergic profile also helps with general anxiety.
I use it to treat migraines and neuralgia, however its benefits to my anxiety are significant.
Zonegran does a whole bunch of stuff, among those things, it is a potent glutamate antagonist.
The APA recommends augmentation treatment with glutamate antagonists when there is limited response in patients with OCD taking antidepressants. A lot of anticonvulsants are glutamate antagonists, so theoretically any one of them can be used. Topamax is a popular choice and probably has the most studies behind it. I only found one case study for Zonegran, however I have used myself and have benefited.
Eric
Posted by Phidippus on December 1, 2011, at 23:51:44
In reply to Re: thinking about a benzo » Phidippus, posted by g_g_g_unit on November 30, 2011, at 22:59:29
The point of treating OCD is raising seratonin levels while lowering dopamine levels. What does an antipsychotic do? It antagonizes dopamine, but also antagonizes seratonin and Zyprexa's main mode of action is to supress seratonin. Zyprexa is effectively robbing you of the seratonin which is already low in your OCD brain. OCD patients usually have to take more antidepressant than that prescribed for depression. When you're brain is sufficiently saturated by AD and you're still having problems with OCD, then its safe to add on an OCD friendly AAP, like Seroquel or Risperdal/Invega to tackle the raised levels of dopamine in your caudate nucleus. I take Latuda and its great.
Stick with the Lexapro and fight the urge to quit at every perceived side effect-most side effects go away with time.
Have you ever been on Lyrica?
Eric
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.