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Dr. Bob is Robert Hsiung, MD,
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Posted by ed_uk2010 on February 12, 2015, at 17:15:31
In reply to Re: What is OCD? For those that don't know...., posted by Bill82 on February 12, 2015, at 16:29:24
>I just got off vortioxetine for 4 months, I had constant drips of urine from my penis along with vocal and motor tics.
You gave it more than long enough. In fact, you did well to continue so long considering its poor tolerability.
The side effects you experienced on Prozac (and Luvox to a lesser extent) were obviously fairly severe so you won't be taking those again.
>I feel like I am lying a lot
You're not. So just say it how it is.
>I do agree though that in the over attentive ocd mind it is easier to imagine side effects that are not real
Oh it does happen. Many of your side effects were clearly physical though eg. the Prozac rash. It's a combination of the two.
Posted by ed_uk2010 on February 12, 2015, at 17:22:42
In reply to Re: What is OCD? For those that don't know.... » ed_uk2010, posted by phidippus on February 12, 2015, at 15:40:37
Clomipramine, the first OCD drug.
What's your take on trying it?
It might help. It has a lot of evidence to back it up.
On the other hand, side effects are very common. Sexual dysfunction, for example.
Unlike SSRIs, clomipramine is anticholinergic. The urinary side effects you experienced on SSRIs were presumably due to some other mechanism. Clomipramine commonly causes dry mouth etc.
Posted by phidippus on February 12, 2015, at 17:54:10
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 12, 2015, at 15:08:22
>For me to describe them it causes a lot of anxiety,
Then perhaps you should describe them repeatedly, until your anxiety reduces.
>I don't do much at all most days except sit around and research ocd/neuro chemistry to instill hope.
What's to research?
>Problem I guess with mine at least it seems so to me is that I just can't seem to let go of the doubt
You don't have to get rid of the doubt. You need to reduce or eliminate the anxiety.
>For now I am not on anything except for minocycline and nac.
Minocycline does some NMDA inhibition and NAC is a glutamate inhibitor. Both drugs are best used as augmentors to therapy with a serotogenic antidepressant.
Eric
Posted by phidippus on February 12, 2015, at 17:56:41
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 12, 2015, at 15:33:16
>i was worried I was begining to accept the thoughts and I didn't like that I guess
If you really want to get better you're going to have to learn that not being anxious about the thoughts does not mean you are accepting the thoughts.
Eric
Posted by phidippus on February 12, 2015, at 18:02:42
In reply to Re: What is OCD? For those that don't know...., posted by Bill82 on February 12, 2015, at 16:29:24
This leaves:
Viibryd
Effexor
Cymbalta
Fetzima
ClomipramineAnd if a med doesn't work for you, you will need to focus on doing real ERP and being dedicated about it.
Eric
Posted by phidippus on February 12, 2015, at 18:06:40
In reply to Re: What is OCD? For those that don't know...., posted by Bill82 on February 12, 2015, at 16:34:43
Alcohol agonizes GABA-A receptors and is a strong NMDA antagonist-an action which indirectly effects glutamate.
Eric
Posted by phidippus on February 12, 2015, at 18:14:58
In reply to Re: What is OCD? » phidippus, posted by ed_uk2010 on February 12, 2015, at 16:36:47
>But, is it possible to think they're a good idea? For example, the woman in my example could allow herself to think the disturbing thoughts and realise that nothing bad actually happens as a result, the thoughts are being allowed to occur as 'exposure'. She's not accepting them as 'good', she's accepting them as harmless.
When you label an anxiety producing thought as 'good', then the thought loses more power because, well, having the thought is considered a good thing - more than just harmless.
In my first exposure I was encouraged to imagine my family as I cut them to pieces with a chainsaw while laughing like an insane man. I was made to reimagine my ideations as a source of humor-something good, rather than something dreadful or simply harmless.
Eric
Posted by phidippus on February 12, 2015, at 18:25:44
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 12, 2015, at 14:53:52
Neurotransmitters and hormones are vastly different things, reach having separate evolutionary pathways.
Serotonin still congregates in nerves that are in the gut.
Also consider adrenaline-it is a hormone secreted by the adrenal glands and can affect great changes in the brain, but it is not a neurotransmitter.
Eric
Posted by ed_uk2010 on February 12, 2015, at 18:27:22
In reply to Re: What is OCD? For those that don't know.... » Bill82, posted by phidippus on February 12, 2015, at 18:02:42
> This leaves:
>
> Viibryd
> Effexor
> Cymbalta
> Fetzima
> Clomipramine
>
> And if a med doesn't work for you, you will need to focus on doing real ERP and being dedicated about it.
>
> EricBill has already tried certain SNRIs, including Cymbalta. It produced a lot of side effects.
Posted by ed_uk2010 on February 12, 2015, at 18:30:11
In reply to Re: What is OCD? » ed_uk2010, posted by phidippus on February 12, 2015, at 18:14:58
>In my first exposure I was encouraged to imagine my family as I cut them to pieces with a chainsaw while laughing like an insane man. I was made to reimagine my ideations as a source of humor-something good, rather than something dreadful or simply harmless.
RE humor.
They do say that learning to laugh at yourself is an important part of being psychologically healthy.
Posted by Bill82 on February 12, 2015, at 21:23:30
In reply to Re: What is OCD? » ed_uk2010, posted by phidippus on February 12, 2015, at 18:14:58
Yea that's where the whole flaw lies at least for me. I would honestly rather die, or live my hole life in this hell than ever let my mind perceive that idea as good. Similar to how certain religious icons have been persecuted and still held faith. Could also be why the types of ocd least responsive is the sexual, violent, religious subtype and the hoarding subtype which I beleive is now no longer considered ocd.
Posted by ed_uk2010 on February 12, 2015, at 22:26:38
In reply to Re: What is OCD?, posted by Bill82 on February 12, 2015, at 21:23:30
>I would honestly rather die, or live my whole life in this hell than ever let my mind perceive that idea as good.
I understand... but you do recognise the ideas are in fact due to OCD. You haven't done anything wrong simply by having a thought - your mind is playing tricks on you. As a result, can you start allowing your mind to *tolerate* the ideas simply based on the fact that no one else is upset or affected by them except you?
Posted by Bill82 on February 12, 2015, at 22:51:24
In reply to Re: What is OCD?, posted by ed_uk2010 on February 12, 2015, at 22:26:38
Yea I think that process has already begun in some way naturally, by becoming reclusive recently I have been able to turn down the amount of triggers, and therefore gained more ability it seems to rationalize that the thoughts are indeed ocd. Hopefully in this state I can either find something to help even more and then slowly re enter society in a meaningful way or if nothing helps see how slowly re entering society goes in a controlled manner(example being eventually taking a class at a school, gradually going back in public more and more, maybe watch tv or look at people in the face again gradually more and more)
Posted by ed_uk2010 on February 13, 2015, at 10:28:07
In reply to Re: What is OCD?, posted by Bill82 on February 12, 2015, at 22:51:24
> Yea I think that process has already begun in some way naturally, by becoming reclusive recently I have been able to turn down the amount of triggers, and therefore gained more ability it seems to rationalize that the thoughts are indeed ocd.
That's a good start. Now you've read about the biology of OCD, I think you should spend as much time reading about its psychology. That could give you a lot of ideas.
Considering that your doc was uncomfortable with pregabalin (Lyrica), would he consider a different antiepileptic such as oxcarbazepine (Trileptal)?
Posted by Bill82 on February 13, 2015, at 13:54:12
In reply to Re: What is OCD?, posted by ed_uk2010 on February 13, 2015, at 10:28:07
It's a possibility, at the moment he last said possibly lamictal, and my origional one said wellbutrin. So that is a thought. There's also amantadine, not sure about that though. I think he more wanted to wait and see about thdgenetic tests.
Posted by phidippus on February 13, 2015, at 14:56:35
In reply to Re: What is OCD?, posted by Bill82 on February 12, 2015, at 21:23:30
I don't think you understand. Good in a sarcastic way. If you have a thought and your response to the thought is, "That's a good idea, I'll rape and kill my mother after I'm done watching The Blacklist." You are sarcastically dismissing the thought and delaying gratification.
>I would honestly rather die, or live my hole life in this hell than ever let my mind perceive that idea as good.
You are fightingg tooth and nail against 'perceiving that idea is good' when in all reality you are never going to really feel like its ok to act out any of your worst thoughts. All your worst thoughts are junk-they aren't real and born of your imagination. The problem is you want to stay anxious about the thoughts because you feel if you aren't anxious about the thoughts you will actually succumb to them which is just not true.
>Could also be why the types of ocd least responsive is the sexual, violent, religious subtype
Then how was I able to overcome the same type of OCD?
You're afraid of the thoughts and you're afraid of the anxiety your thoughts generate. And the funny thing is your thoughts aren't real.
Eric
Posted by phidippus on February 13, 2015, at 15:00:52
In reply to Re: What is OCD?, posted by Bill82 on February 13, 2015, at 13:54:12
Weellbutrin?! Doc has no idea what they're doing. Wellbutrin is more likely to worsen anxiety.
Eric
Posted by ed_uk2010 on February 13, 2015, at 16:20:08
In reply to Re: What is OCD? » Bill82, posted by phidippus on February 13, 2015, at 14:56:35
>You are fighting tooth and nail against 'perceiving that idea is good' when in all reality you are never going to really feel like its ok to act out any of your worst thoughts. All your worst thoughts are junk-they aren't real and born of your imagination. The problem is you want to stay anxious about the thoughts because you feel if you aren't anxious about the thoughts you will actually succumb to them which is just not true.
Very well said, IMO. That's a great summary.
The thoughts are just thoughts, they are not reality, and there is no way Bill is going to act out on them. People who actually do act out on bad thoughts do not spend hours having OCD about them!
Once Bill is not anxious about the thoughts, he won't act out on them... they will just eventually go away.
I don't think Wellbutrin would help OCD. I know the doctor mentioned Lamictal, which seemed to produce some emotional numbing before. Although not highly evidence based, I was wondering whether a different AED such as Trileptal might help. I know Bill's doc didn't want to use Lyrica.
Posted by Bill82 on February 13, 2015, at 16:22:35
In reply to Re: What is OCD? » Bill82, posted by phidippus on February 13, 2015, at 15:00:52
Haha yea that's what I've thought, this is the same doctor who said the car thing, I don't think she even knows what ocd is, I am just trying to be respectful, not sure if I would take it if she offered, but then again don't have much to lose haha. And yea I already do perceive them in sarcastic way at times, it's just with these it at times seems I actually like it which scares me ect ect. I don't know maybe in stubborn, but I get what you are saying. I had ocd onset very suddenly, before I had it I used to have intrusive thoughts all the time. Usually when I was anxious they would get worse but i would just chuckle. For example if be on a date and imagine if I just shouted something embaressing, it would just make me chuckle inside and is forget about it. When the ocd onset I was paralyzed with anxiety, and it almost seemed to stick with me in a ptsd like way, so that now after months of obsessivng my mind has changed and I guess "I don't joke around" with my thoughts. I know they are not real, but maybe it seems at some level I lack insight? Or maybe I'm just stubborn, not sure but that's the best way I could describe it. Also eric what are your thoughts on amantadine, as it has shown effect in ocd but and in a rat model was superior to memantine, being more active in the striatum, but it is also positively affects dopamine transmission(not exactly sure how, I think it encourages more to be released and may be an agonist not sure). I think memantine is also a d2agonist but that it's affinity is negligible.
Posted by Bill82 on February 13, 2015, at 16:26:19
In reply to Re: What is OCD?, posted by ed_uk2010 on February 13, 2015, at 16:20:08
Have not heard of trileptal before it seems interesting. I see there's one rat model that shows effectivness. Consumer reports of people on an epilepsy bored who had ocd and couldn't take ssri due to lowered seizure threshold said it didn't seem to alter the ocd all that much, but that dosnt mean it couldn't help me. I'll have to run it by him, the AED are very interesting in how different they all are from one another and how many there are, increases the chance they could help. Thanks for the responses guys
Posted by Bill82 on February 13, 2015, at 16:39:48
In reply to Re: What is OCD? » Bill82, posted by phidippus on February 13, 2015, at 15:00:52
I have 2 p docs at the moment, thought if clarify that. One is a ho hum basic one covered by insurance, the other is a specialist in ocd.
Posted by phidippus on February 14, 2015, at 0:51:29
In reply to Re: What is OCD?, posted by ed_uk2010 on February 13, 2015, at 16:20:08
>Although not highly evidence based, I was wondering whether a different AED such as Trileptal might help. I know Bill's doc didn't want to use Lyrica.
To augment treatment of OCD with an SSRI it is recommended that a anti-glutamatergic agent be added. Some of these agents include Keppra, Riluzole, Zonegran, Lamictal, Lyrica, Neurontin and Topomax. Trileptal would not be suitable because it is not anti-glutamatergic.
Eric
Posted by phidippus on February 14, 2015, at 1:07:32
In reply to Re: What is OCD?, posted by Bill82 on February 13, 2015, at 16:22:35
>it's just with these it at times seems I actually like it which scares me ect ect.
It is not uncommon for patients with OCD suffering pedophilic obsessions sometimes get sensations in their privates which they will mistake for real arousal.
The thought that you 'actually like' the thoughts is part of the OCD. The challenge is to confront those thoughts, agree with them and disregard them as more nonsense. Again you're being scared of being scared of something that's not real.
>my mind has changed and I guess "I don't joke around" with my thoughts.
I implore you to change that policy because humor goes a long way to diffusing fear and anxiety.
>I know they are not real, but maybe it seems at some level I lack insight?
I don't think you lack insight, I just think very wrapped up in feeling afraid.
>What are your thoughts on amantadine?
I've seen one case study which was positive.
I have used it myself and perceived no effect.
Eric
Posted by ed_uk2010 on February 14, 2015, at 9:49:31
In reply to Re: What is OCD? » ed_uk2010, posted by phidippus on February 14, 2015, at 0:51:29
>Some of these agents include Keppra, Riluzole, Zonegran, Lamictal, Lyrica, Neurontin and Topomax. Trileptal would not be suitable because it is not anti-glutamatergic.
According to the studies on PubMed, it seems that all the AEDs which act as Na+ channel blockers, including oxcarbazepine (Trileptal), inhibit the release of glutamate. Carbamazepine (Tegretol), oxcarbazepine, lamotrigine (Lamictal) and phenytoin are among the most potent and widely used Na+ channel blockers, but several other AEDs have this property too. To what extent inhibiting glutamate release is useful in OCD is not well understood, it seems.
Posted by Bill82 on February 14, 2015, at 12:00:40
In reply to Re: What is OCD? » phidippus, posted by ed_uk2010 on February 14, 2015, at 9:49:31
What opinions do you guys have on glyx13. Two things it's being tested for atm in phase 3 is ocd and depression. Lady who is doing ocd study is a little over zealous about ketamine working in ocd in my opinion though, but then again she could be right.
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