Psycho-Babble Medication Thread 1053210

Shown: posts 1 to 18 of 18. This is the beginning of the thread.

 

Prozac Derealization But Improved OCD

Posted by Exisessentialist on October 28, 2013, at 8:14:41

Hi, all. A little over two weeks ago, in addition to 450 mg Wellbutrin XL daily and 15 mg zopiclone for sleep, I was put on fluoxetine for OCD and anxiety symptoms. Over the course of 12 days, my dose has increased from 20 to 40 and ultimately 60 mg. This dose was reached five days ago. My OCD ritualizations have improved dramatically but I'm suffering from an increased experience of depersonalization, which was one of my primarily symptoms already, to the point that I feel I don't have a self. Accordingly, my depression has worsened. Will these prove to be transient effects? How long until I can give it an accurate assessment?
Any help is appreciated. Thank you.

 

Re: Prozac Derealization But Improved OCD » Exisessentialist

Posted by Phillipa on October 28, 2013, at 10:24:50

In reply to Prozac Derealization But Improved OCD, posted by Exisessentialist on October 28, 2013, at 8:14:41

Why was the dose increased? You had the derealization on the lower doses also. Maybe the accumulation of Prozac in the body? Phillipa

 

Re: Prozac Derealization But Improved OCD » Phillipa

Posted by Exisessentialist on October 28, 2013, at 12:27:49

In reply to Re: Prozac Derealization But Improved OCD » Exisessentialist, posted by Phillipa on October 28, 2013, at 10:24:50

I'm actually recognizing that I've had some degree of depersonalization all of my life but I hadn't recognized it before because I had no basis for comparison. It didn't emerge with treatment of fluoxetine but, hopefully temporarily, it's been amplified by it.

 

Re: Prozac Derealization But Improved OCD » Exisessentialist

Posted by doxogenic boy on October 28, 2013, at 13:56:36

In reply to Prozac Derealization But Improved OCD, posted by Exisessentialist on October 28, 2013, at 8:14:41

>Accordingly, my depression has worsened.

You shouldn't wait too long with changing your meds when it has worsened your depression. Sometimes it helps to try another SSRI. What other meds have you tried?

- doxogenic

 

Re: Prozac Derealization But Improved OCD

Posted by Exisessentialist on October 29, 2013, at 8:30:10

In reply to Re: Prozac Derealization But Improved OCD » Exisessentialist, posted by doxogenic boy on October 28, 2013, at 13:56:36

I failed to mention that days before I began the fluoxetine, I abruptly discontinued quetiapine at 112.5 mg, which could easily be contributing to my difficulties via withdrawal syndrome. I think the fluoxetine is working as my OCD ritualizations are the least they've been in years but being in the limbo period where it hasn't improved my mood yet and seems to be increasing anxiety is challenging to say the least.

 

Re: Prozac Derealization But Improved OCD

Posted by Christ_empowered on October 29, 2013, at 11:53:11

In reply to Re: Prozac Derealization But Improved OCD, posted by Exisessentialist on October 29, 2013, at 8:30:10

maybe a short-term benzo?

 

Re: Prozac Derealization But Improved OCD » Exisessentialist

Posted by doxogenic boy on October 29, 2013, at 18:23:10

In reply to Re: Prozac Derealization But Improved OCD, posted by Exisessentialist on October 29, 2013, at 8:30:10

> I failed to mention that days before I began the fluoxetine, I abruptly discontinued quetiapine at 112.5 mg, which could easily be contributing to my difficulties via withdrawal syndrome. I think the fluoxetine is working as my OCD ritualizations are the least they've been in years but being in the limbo period where it hasn't improved my mood yet and seems to be increasing anxiety is challenging to say the least.

Then it is difficult to tell what is quetiapine withdrawal and what is fluoxetine side effects. How long did you use quetiapine, and why did you abruptly discontinue it?

- doxogenic

 

Re: Prozac Derealization But Improved OCD » doxogenic boy

Posted by exisessentialist on October 29, 2013, at 18:28:45

In reply to Re: Prozac Derealization But Improved OCD » Exisessentialist, posted by doxogenic boy on October 29, 2013, at 18:23:10

I was only one quetiapine for six or seven weeks. It was intended to alleviate insomnia and OCD but contributed to rhinosinusitis, with which I already have great difficulty.

 

Re: Prozac Derealization But Improved OCD » exisessentialist

Posted by doxogenic boy on October 29, 2013, at 19:09:17

In reply to Re: Prozac Derealization But Improved OCD » doxogenic boy, posted by exisessentialist on October 29, 2013, at 18:28:45

> I was only one quetiapine for six or seven weeks. It was intended to alleviate insomnia and OCD but contributed to rhinosinusitis, with which I already have great difficulty.

I don't know if you could have a bad quetiapine withdrawal after only six or seven weeks on a low dose. I have found information which go in both directions.

Fluoxetine can induce depersonalization syndrome:

http://www.ncbi.nlm.nih.gov/pubmed/1961868
(no abstract available)
Quote:
Psychosomatics. 1991 Fall;32(4):468-9.
Depersonalization syndrome induced by fluoxetine.
Black DW, Wojcieszek J.
End quote.

But fluoxetine has also been used as a treatment in depersonalization disorder (not successfully):

http://bjp.rcpsych.org/content/185/1/31.long
Excerpt:
CLINICAL IMPLICATIONS

Fluoxetine is not efficacious in treating primary depersonalisation.

The widespread use of serotonin reuptake inhibitors to treat depersonalisation in clinical practice appears unfounded.

The unresponsiveness of depersonalisation to fluoxetine supports the concept that depersonalisation disorder is a dissociative rather than a depression/anxiety spectrum disorder
End quote.

And quetiapine can cause depersonalization too:

http://www.unboundmedicine.com/medline/citation/11565631/A_case_of_depersonalization_derealization_syndrome_during_treatment_with_quetiapine_

From the link above:

A case of depersonalization-derealization syndrome during treatment with quetiapine.

Abstract

A case who schizophrenia developed patient male of a 65-year-old is reported depersonalization-derealization syndrome following treatment with quetiapine, an atypical antipsychotic. The literature is reviewed for possible biological mechanisms that may account for this phenomenon.
End quote.

- doxogenic

 

Re: Prozac Derealization But Improved OCD » doxogenic boy

Posted by Exisessentialist on November 2, 2013, at 13:40:20

In reply to Re: Prozac Derealization But Improved OCD » exisessentialist, posted by doxogenic boy on October 29, 2013, at 19:09:17

Is there anything that you're aware of that seems promising for derealization/depersonalization? Everything I've encountered stated that there's no conventional standard treatment but lamotrigine showed some promise in specific populations. I'm still curious if the initial, severe start-up effects of adding the fluoxetine are indicative of its potential efficacy if I can hold-on until the side effects subside. A couple of big ifs...

 

Re: Prozac Derealization But Improved OCD » Exisessentialist

Posted by doxogenic boy on November 4, 2013, at 13:11:45

In reply to Re: Prozac Derealization But Improved OCD » doxogenic boy, posted by Exisessentialist on November 2, 2013, at 13:40:20

> Is there anything that you're aware of that seems promising for derealization/depersonalization?

Here is what I found:
http://www.ncbi.nlm.nih.gov/pubmed/23118274
Quote:
Behav Modif. 2013 Mar;37(2):226-42. doi: 10.1177/0145445512461651. Epub 2012 Nov 1.
A preliminary evaluation of repeated exposure for depersonalization and derealization.
Weiner E, McKay D.
Source

Department of Psychology, Fordham University, Bronx, NY 10458, USA.
Abstract

Dissociative symptoms including depersonalization and derealization are commonly experienced by individuals suffering from panic disorder or posttraumatic stress disorder (PTSD). Few studies have been published investigating the specific treatment of these symptoms in individuals diagnosed with panic disorder or PTSD, despite evidence that the subset of individuals with panic disorder who experience depersonalization and derealization report more panic attacks as well as greater panic severity and functional impairment. Furthermore, it has been shown that these symptoms can impede treatment and recovery in PTSD. Finally, recent research has shown that interoceptive exposure generally enhances the efficacy of treatment outcome for PTSD and PTSD with comorbid panic. This study investigated the use of a novel interoceptive exposure technique for treatment of depersonalization and derealization in individuals with high anxiety sensitivity and/or symptoms of PTSD. Results indicated significant reductions on six of seven items as well as total score on an outcome measure of depersonalization and derealization. Thus, this technique appears to hold promise for utilization as a form of interoceptive exposure in the treatment of these symptoms.
End quote.

http://www.ncbi.nlm.nih.gov/pubmed/22545565
Quote from the link above:
J Trauma Dissociation. 2012;13(3):311-29. doi: 10.1080/15299732.2011.606742.
Psychophysiological investigations in depersonalization disorder and effects of electrodermal biofeedback.
Schoenberg PL, Sierra M, David AS.
Source

Depersonalization Research Unit, King's College London, London, England. poppy.schoenberg@kcl.ac.uk
Abstract

Previous studies investigating depersonalization disorder (DPD) report a lower baseline skin conductance level (SCL) and attenuated skin conductance response (SCR) to emotive stimuli. We hypothesized that increasing physiological arousal levels via electrodermal biofeedback may ameliorate disembodiment and emotional numbing symptomatology. Real-time versus sham biofeedback yielded a significant SCL increase after just 3 real-time biofeedback sessions in healthy volunteers. Subsequently, a randomized controlled biofeedback trial was administered with DPD patients. Findings were not replicated as SCL tended to fall, curiously more substantially in the real-time condition, concomitant with increased low- and high-frequency heart rate variability. To further investigate abnormal autonomic regulation in DPD, we compared basal autonomic activity between patients and healthy volunteers and found the former to be significantly more labile, indexed by greater nonspecific SCRs and higher resting SCLs. Rather than low sympathetic arousal, DPD might be better characterized by abnormal autonomic regulation affecting emotional and physiological responsivity.
End quote.

Have you tried rTMS?
http://www.ncbi.nlm.nih.gov/pubmed/23941986
(no abstract available) From the link above:
Brain Stimul. 2013 Aug 6. pii: S1935-861X(13)00228-3. doi: 10.1016/j.brs.2013.07.006. [Epub ahead of print]
Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Specific Symptom Clusters in Depersonalization Disorder (DPD).
Christopeit M, Simeon D, Urban N, Gowatsky J, Lisanby SH, Mantovani A.

>Everything I've encountered stated that there's no conventional standard treatment but lamotrigine showed some promise in specific populations.

Yes, it says so in this article:
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462012000400021&lng=en&nrm=iso&tlng=en

Excerpt from the link above:
Dear Editor,

Depersonalization disorder (DPD), a chronic condition characterized by a profound disruption of self-awareness, appears to be more common than previously thought and may possibly affect 1% of the general population.1,2 DPD usually presents with severe distress and functional disability. Because some of the symptoms may resemble those of psychotic and anxiety disorders (affect numbing, disembodiment, and social anxiety), DPD is often misdiagnosed.1,2 There is no established treatment for this disorder.2 We describe a case that illustrates the particularities of DPD and proposals for treatment.

[...]

As the patient did not respond to risperidone 2 mg/day, it was replaced with a selective serotonin reuptake inhibitor (SSRI), which led to anxiety improvement, but the specific symptoms of DPD grew worse. A subsequent change to venlafaxine 225 mg/day led to a significant mood improvement and a reduction in panic-like episodes; however, depersonalization and derealization remained unchanged.

Lamotrigine was then added at an initial dose of 25 mg/day, with a gradual increase to up to 200 mg/day. The patient had significant improvement in different aspects, such as affect, interpersonal contact and social interaction. The depersonalization symptoms gradually decreased, which made it possible for the patient to go back to work.
End quote.

>I'm still curious if the initial, severe start-up effects of adding the fluoxetine are indicative of its potential efficacy if I can hold-on until the side effects subside. A couple of big ifs...

Has it changed now?

 

Re: Prozac Derealization But Improved OCD » Exisessentialist

Posted by exisessentialist on November 8, 2013, at 10:01:43

In reply to Prozac Derealization But Improved OCD, posted by Exisessentialist on October 28, 2013, at 8:14:41

I had to discontinue the fluoxetine as the derealization and panic attacks were beyond tolerable. Things haven't improved much upon discontinuation but I'm mulling over either adding pregabalin or buspirone for anxiety/OCD. Any recommendations? My wellbutrin has also been decreased to 300 mg xl daily to see if it was contributing to anxiety.

 

Re: Prozac Derealization But Improved OCD » exisessentialist

Posted by doxogenic boy on November 8, 2013, at 12:53:42

In reply to Re: Prozac Derealization But Improved OCD » Exisessentialist, posted by exisessentialist on November 8, 2013, at 10:01:43

Have you tried clomipramine? It works for OCD. Maybe you can take it in combination with pregabalin or buspirone. I got more anxiety when I used bupropion.

- doxogenic

 

Re: Prozac Derealization But Improved OCD

Posted by Exisessentialist on November 22, 2013, at 21:22:51

In reply to Re: Prozac Derealization But Improved OCD » exisessentialist, posted by doxogenic boy on November 8, 2013, at 12:53:42

I believe the pregabalin is assisting with the anxiety as I'm at least able to express negative opinions, something I'm not used to even being able to consider expressing. If all of the SSRIs made my condition worse, is it worth trying clomipramine for OCD or depression? I know it's not a selective serotonin reuptake inhibitor but it does prevent serotonin reuptake. I have also seen at least one study on it being effective for depersonalization disorder.
I've also tried nortriptyline for depression in the past but it was in combination with sertraline and tryptophan. I'd be interested in seeing what it does without the serotonin modulators.

 

Re: Prozac Derealization But Improved OCD » Exisessentialist

Posted by doxogenic boy on November 23, 2013, at 9:02:12

In reply to Re: Prozac Derealization But Improved OCD, posted by Exisessentialist on November 22, 2013, at 21:22:51

> I believe the pregabalin is assisting with the anxiety as I'm at least able to express negative opinions, something I'm not used to even being able to consider expressing. If all of the SSRIs made my condition worse, is it worth trying clomipramine for OCD or depression?

That's a good question. Clomipramine is probably the only TCA that works for OCD, because of its serotonergic effects, so there is a risk of worsening the condition. When this happened on SSRIs, how long did it last after you stopped taking them before the side effects went away? Could you try clomipramine for a short period of time, and then stop if it worsens the depersonalization syndrome?

> I've also tried nortriptyline for depression in the past but it was in combination with sertraline and tryptophan. I'd be interested in seeing what it does without the serotonin modulators.

If you don't take a serotonergic antidepressant, do you think your OCD will become considerably worse, and could you handle that with exposure and response prevention therapy? Then it would be easier to treat the depersonalization, if all serotonergic antidepressants worsen it.

- doxogenic

 

Re: Prozac Derealization But Improved OCD » doxogenic boy

Posted by Exisessentialist on November 23, 2013, at 10:51:24

In reply to Re: Prozac Derealization But Improved OCD » Exisessentialist, posted by doxogenic boy on November 23, 2013, at 9:02:12

I'm not sure how exposure and response prevention therapy works with respect to purely mental compulsions but I'm game to try it. I don't think my current psychiatrist would be willing to allow me to try clomipramine for a short period. They seem displeased that I'm already requesting so many changes.

 

Re: Prozac Derealization But Improved OCD » Exisessentialist

Posted by doxogenic boy on November 23, 2013, at 15:47:30

In reply to Re: Prozac Derealization But Improved OCD » doxogenic boy, posted by Exisessentialist on November 23, 2013, at 10:51:24

> I'm not sure how exposure and response prevention therapy works with respect to purely mental compulsions but I'm game to try it.

There also is paradoxical intention. It has helped me dramatically with obsessions sometimes.

http://www.studentpulse.com/articles/660/2/viktor-frankls-logotherapy-the-search-for-purpose-and-meaning
Quote from the link above:
The logotherapeutic technique used to help patients with anticipatory anxiety was coined as paradoxical intention (Hatt, 1965). Paradoxical intention is an approach that guides a patient to intend that which they fear. This treatment has been shown to break neurotic cycles brought on by anticipatory anxiety and hyper-intention. For example, a patient who has a fear of insomnia (anticipatory anxiety) will try hard (hyper-intend) to fall asleep, which incapacitates the patients ability to sleep. A logotherapist would propose the paradoxical intention of trying not to fall asleep, which would be followed by sleep (Frankl, 1959). The success of paradoxical intention is called dereflection meaning attention and reflection has now been refocused to the proper object (Ponsaran, 2007). It should be noted that Frankl did not claim paradoxical intention to be a panacea but rather a unique tool that has been shown to be efficacious in treating phobias and obsessive compulsions (Frankl, 1959).
End quote.

http://marshallhlewis.net/IFL2005/v19n2/v19n2a6.pdf

- doxogenic

 

Re: Prozac Derealization But Improved OCD

Posted by Englishman006! on November 28, 2013, at 22:02:54

In reply to Prozac Derealization But Improved OCD, posted by Exisessentialist on October 28, 2013, at 8:14:41

Hi Exisessentialist, how are you travelling? With regard to your cocktail, wellbutrin may well have been contributing to your anxiety. It can also cause irritability.

Often 20mg prozac is enough to get a slight anti-OCD effect.

As far as the depersonalisation/derealisation is concerned I would recommend Lamotrigine. It must be started at low dose (25mg) and be slowly increased weekly - watch for any rash, if detected STOP immediately. Aim for 200-300mg. You may also experience some relief of your OCD and certainly your depression should improve.

It may be a good idea to streamline your other meds and reduce/come off some of them.

A benzodiazapine for emergencies may be of some comfort until you are stabilised?

Dissociative disorders are more a result of glutamate disregulation than anything else.

I understand that too many opinions can complicate matters but I believe Lamotrigine (Lamictal) is definitely worth considering.

Regards

Shaun


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