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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by phidippus on November 1, 2012, at 21:45:42
I have ADHD/BP1/OCD
I am on Abilify 15 mg, Lithium 1200 mg, Mirtazapine 30 mg, Viibryd 60 mg, Vyvanse 70 mg, 100 mg Seroquel and 50 mg Oxycodone.
I'm doing well on my cocktail except am fighting a depression that has me running at 75% when I should be at 90% or better. My depression consists of lack of motivation, a plague of negative thoughts, ruminations and thoughts of suicide.
My doctor has decided to add Mirtazapine in the hopes of bettering my mood. He's starting me at 30 mg.
Should I be worried about serotonin syndrome?
Does Mirtazapine agonize dopamine? Is the effect significant?
Do I run the risk of becoming manic?
Who are you voting for?
Eric
www.esness.com
Posted by rjlockhart37 on November 1, 2012, at 22:32:02
In reply to Added another AD-just a couple questions., posted by phidippus on November 1, 2012, at 21:45:42
i looked it up....its actually a popular combination, used alot with for anxiety due to its serotonin impact...it definelty doesnt cause SERO syndrome because it would have already been documented by articles and reviews from people online. If you took paxil with viibyrd that would be a totally diffrent case. It is kinda confusing because it does act like SSRI's but its a tetracyclic antidepressant. Who knows....but i pulled something up that may be of intrest...
http://apt.rcpsych.org/content/15/2/90.full
hope it makes you feel better...its used alot offlabel for sleep problems at night.
r
Posted by phidippus on November 1, 2012, at 22:42:07
In reply to Re: Added another AD-just a couple questions., posted by rjlockhart37 on November 1, 2012, at 22:32:02
That's some great info. Thanks.
I'm just worried about SS because I'm on so many serotogenic medications!
Eric
Posted by phillipa on November 2, 2012, at 0:16:32
In reply to Re: Added another AD-just a couple questions. » rjlockhart37, posted by phidippus on November 1, 2012, at 22:42:07
Where's the serotonin other than viibry & tramadol? Phillipa
Posted by phidippus on November 2, 2012, at 15:52:12
In reply to Re: Added another AD-just a couple questions. » phidippus, posted by phillipa on November 2, 2012, at 0:16:32
Vyvanse and Lithium
Eric
Posted by phillipa on November 2, 2012, at 20:37:01
In reply to Re: Added another AD-just a couple questions. » phillipa, posted by phidippus on November 2, 2012, at 15:52:12
Serotonin? Seriously? I've not heard of this before. Phillipa
Posted by phidippus on November 2, 2012, at 21:18:48
In reply to Re: Added another AD-just a couple questions. » phidippus, posted by phillipa on November 2, 2012, at 20:37:01
Both dextroamphetamine and lithium release serotonin.
Eric
Posted by jono_in_adelaide on November 2, 2012, at 23:15:59
In reply to Added another AD-just a couple questions., posted by phidippus on November 1, 2012, at 21:45:42
The risk of seretonin syndrome is 3/5 of 5/8 of f*ck all
Mirtazapine doesnt antagonise dopamine
It is effective and safe
Mania is a possability
Other alternatives might be wellbutrin or nortriptyline, if mortazapine hasnt worked in 4 weeks
Posted by rjlockhart37 on November 2, 2012, at 23:22:47
In reply to Re: Added another AD-just a couple questions., posted by jono_in_adelaide on November 2, 2012, at 23:15:59
hey eric....i don't think damphetamine works on SERO...of course I could be wrong, but back in the day when i researched alot about the amphetamines....methamphetamine does release serotonin...that's why its more euphoric than damphetamine...but mamphetamine is more likely to cause nuero damage but that's usally when its used on the street.
anyways...you know i have read articles its used to OCD...
r
Posted by phidippus on November 3, 2012, at 15:22:09
In reply to Re: Added another AD-just a couple questions., posted by rjlockhart37 on November 2, 2012, at 23:22:47
>i don't think damphetamine works on SERO
It does.
"dextroamphetamine has minuscule effect on the serotonin transporter" - Wikipedia
>anyways...you know i have read articles its used to OCD...
It helps with my OCD.
Eric
Posted by brynb on November 3, 2012, at 20:38:54
In reply to Re: Added another AD-just a couple questions., posted by phidippus on November 3, 2012, at 15:22:09
Hi Eric,
I'm hopping on your thread here as I think I have OCD and it's progressively getting worse. What med have you found to be the most helpful for it? How do I know if that's indeed what I have (anxiety, ruminating thoughts, negative loops and dark thoughts over and over again, and more, but I'll stop there)?
Oh, as for the election, let's just say I'm hoping a certain incumbent gets the ax ;).
Posted by phidippus on November 3, 2012, at 21:35:32
In reply to OCD, posted by brynb on November 3, 2012, at 20:38:54
>I think I have OCD and it's progressively getting worse...negative loops and dark thoughts over and over again, and more...
If you are having intrusive thoughts that are becoming recurrent you could be experiencing OCD.
>What med have you found to be the most helpful for it?
I have found Clomipramine, Mirtazapine, Viibryd, Abilify and Keppra to be the most helpful medications I've used to treat my OCD.
OCD involves a defecit of serotonin, a surplus of dopamine and noradrenaline in the brain. First line of treatment for OCD is a high dose antidepressant-those recommended by the American Psychiatric Association are SSRIs, Effexor, Mirtazapine and Clomipramine (which is considered the gold standard for OCD). If one experiences only some response with an antidepressant, augmentation with an atypical antipsychotic is recommended. If that still doesn't do the trick, augmentation with a glutamate antagonist is recommended-Topomax and Lyrica are examples of glutamate antagonists.
You're currently taking 20 mg of Lexapro. A dose of 40 mg would be sufficient to treat OCD.
If you're having OCD symptoms despite the Lexapro, I would recommend trying another SSRI-Luvox might be a good choice.
You said 'and more'. What more is there?
Eric
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
DSM IV Obsessive Compulsive Disorder (OCD) CriteriaA. Either obsessions or compulsions:
Obsessions as defined by (1), (2), (3), and (4):
(1) recurrent and persistent thoughts, impulses, or images that are experienced at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
(2) the thoughts, impulses, or images are not simply excessive worries about real-life problems
(3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
(4) the person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion)
Compulsions as defined by (1) and (2):
(1) repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
(2) the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive
B. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable. Note: This does not apply to children.
C. The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour a day), or significantly interfere with the persons normal routine, occupational (or academic) functioning, or usual social activities or relationships.
D. I another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it (e.g., preoccupation with food in the presence of an Eating Disorder; hair pulling in the presence of Trichotillomania; concern with appearance in the presence of Body Dysmorphic Disorder; preoccupation with drugs in the presence of a Substance Use Disorder; preoccupation with having a serious illness in the presence of Hypochondriasis; preoccupation with sexual urges or fantasies in the presence of a Paraphilia; or guilty ruminations in the presence of Major Depressive Disorder).
E. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
http://www.cnsforum.com/imagebank/section/neurochemical_pathways_OCD/default.aspx
Eric
Posted by brynb on November 4, 2012, at 1:16:40
In reply to Re: OCD » brynb, posted by phidippus on November 3, 2012, at 21:35:32
The "more" is the embarrassing stuff : constant guilt (over things I've done/said/think/feel), reading something over and over again, constantly organizing things and lining them up in my medicine cabinet and around my apartment, checking the lock on my door again and again, repeating things in my head and out loud to people, and the worst--ugh--picking my scalp.
My pdoc mentioned that if we're going to look at my Dx as bipolar (he's not certain what my Dx is yet), he wants to lower my Lexapro dose once my depression is better. I trust him and think he's good, but I don't agree with that. Maybe I need a different AD (it just can't touch dopamine or norepinephrine), or an AP (though I don't like the idea of being on one). But, a while back, I was on Invega, and I had a positive response to it.
It would be nice to just take one little magic pill that solved everything!
Posted by phidippus on November 4, 2012, at 1:06:48
In reply to Re: OCD » phidippus, posted by brynb on November 4, 2012, at 1:16:40
>constant guilt (over things I've done/said/think/feel)
This is more a symptom of depression.
>reading something over and over again, constantly organizing things and lining them up in my medicine cabinet and around my apartment, checking the lock on my door again and again, repeating things in my head and out loud to people, and the worst--ugh--picking my scalp.
You have OCD. Picking of the scalp is referred to as trichotillomania.
>My pdoc mentioned that if we're going to look at my Dx as bipolar (he's not certain what my Dx is yet), he wants to lower my Lexapro dose once my depression is better.
This strikes me as a very bad idea. I don't think you are bipolar. Now that you've opened up, I'm pretty confident you are struggling with depression and OCD. Lowering your Lexapro dose will worsen your symptoms.
Please talk to your doctor about the checking and the trichotillomania. This will cement a diagnosis of OCD and give your doctor direction.
>Maybe I need a different AD (it just can't touch dopamine or norepinephrine)
I think you might want to try another SSRI, Mirtazapine or Clomipramine.
Most of the SSRIs are serotonin selective and do not inhibit the reuptake of norepenephrine or dopamine. Sertraline is the only exception I know of as it is a dopamine reuptake inhibitor. That leaves plenty of SSRIs to choose from: Prozac, Paxil, Viibryd, Luvox and Celexa.
>I was on Invega, and I had a positive response to it.
This is a good sign. I'm thinking the right AD combined with Invega might be all you need.
Remember, if you don't have a full response to an AD, augmentation with an AP could be the ticket. If you don't like the idea of being on an AP, you can always try Topomax or Lyrica.
>It would be nice to just take one little magic pill that solved everything!
If all we are dealing with is OCD and depression, you might only need one pill-the Lexapro or another AD. If I were your doctor, I would stop everything except the Lexapro, bump it up to 40 mg and see what happens. If you become manic, which I doubt you will, then we can solidify a dx of bipolar with OCD. If your symptoms improve, both depressive and obsessive then we're in the right ballpark.
What happens if you become manic? Well, just start the lithium back up, but you'll need a higher dose to balance out the AD. Hopefully you won't panic and mistake your anxiety symptoms for mania.
If the OCD symptoms don't diminish, then you can try another AD (I'd start with Luvox-its OCD specific) or you can add Invega or you can try Topomax, Keppra or Lyrica. You have a lot of choices, but (this is important) stay on your AD-it is the first weapon against OCD.
Eric
ps. Did you know that Tramadol is used to treat OCD? It makes a lot of sense to me now that you responded well to it.
Posted by brynb on November 4, 2012, at 9:03:25
In reply to Re: OCD » brynb, posted by phidippus on November 4, 2012, at 1:06:48
Thanks, Eric. You're always so helpful =).
How much do I owe you? (You're a better listener than my shrink!)
-b
Posted by phidippus on November 4, 2012, at 18:02:57
In reply to Re: OCD » phidippus, posted by brynb on November 4, 2012, at 9:03:25
20 bucks!
Eric
Posted by phillipa on November 4, 2012, at 21:16:19
In reply to Re: OCD » brynb, posted by phidippus on November 4, 2012, at 18:02:57
Got me confused. You like luvox better than lexapro? And what about a bit of both together like I'm taking with benzos? Phillipa
Posted by phidippus on November 4, 2012, at 21:40:05
In reply to Re: OCD » phidippus, posted by phillipa on November 4, 2012, at 21:16:19
Luvox is specifically approved for OCD. There's no point in taking two ADs if one will do.
Eric
Posted by brynb on November 5, 2012, at 9:36:42
In reply to Re: OCD » brynb, posted by phidippus on November 4, 2012, at 18:02:57
> 20 bucks!
>
> Ericthat's a lot less than my pdoc ;)!
Posted by Phillipa on November 5, 2012, at 17:58:48
In reply to Re: OCD » phidippus, posted by brynb on November 5, 2012, at 9:36:42
Eric thanks Phillipa
This is the end of the thread.
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