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Dr. Bob is Robert Hsiung, MD,
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Posted by phidippus on February 12, 2015, at 13:51:24
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 11, 2015, at 17:54:32
>it's a deal breaker to in that I just can't do it I guess
I'm sure you can do it. It probably just causes you a lot of anxiety.
It IS the most effective way of treating OCD.
>As for the testosterone impotence thing it just prevents me from having motivation to try new meds I guess cause my mind can't see them as long term solutions?
I've been on ADs for OCD for many years. There is no doubt they can be a long term solution.
>just want to check To make it feel right.
What exactly does that mean?
>If it was addiction wouldn't it be ego syntonic?
Not necessarily.
>Do any medicines help to allow the person to get rid of the doubting or are they just for allowing for the person to disengage compulsions?
Serotogenic antidepressants help with both.
Eric
Posted by phidippus on February 12, 2015, at 13:54:16
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 11, 2015, at 18:00:19
>I thought neurotransmitters or at least seritonin were a form of hormone?
Serotonin is a neurotransmitter.
Testosterone is a hormone.
http://www.differencebetween.com/difference-between-neurotransmitters-and-vs-hormones/
Eric
Posted by phidippus on February 12, 2015, at 14:17:43
In reply to Re: What is OCD? For those that don't know...., posted by Bill82 on February 11, 2015, at 21:21:36
>I masturbate to check that I am not aroused to the thoughts, which can last for hours.
Am I to understand you flagellate your flaccid penis for a long time in hopes of not gaining an erection?
What kind of sexual thoughts do you have? Tell me how much anxiety it causes to describe your thoughts.
There are ADs that don't cause sexual disfunction: Viibryd and Mirtazapine.
Eric
Posted by Bill82 on February 12, 2015, at 14:53:52
In reply to Re: OCD Dont know where to go » Bill82, posted by phidippus on February 12, 2015, at 13:54:16
Well I know it's a neurotransmitter, but I thought all neurotransmitters were offshoots from hormones originally in terms of evolution. Cause seritonin a greatest concentration is in the gut, and there I beleive it has a lot of hormonal seeming activity along with it's neuro transmission aspect
Posted by Bill82 on February 12, 2015, at 15:08:22
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 12, 2015, at 14:53:52
For me to describe them it causes a lot of anxiety, enough to make my once successful life into the state I am now where I don't do much at all most days except sit around and research ocd/neuro chemistry to instill hope.
And that's a very good parallel edu, thanks for that. 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, possibly because I have been so tormented and had so much trauma all I do is stay in a stasis like mode of doing the same thing over again because my mind views it this way as at least not changing anymore. In other words dealing with it in order to acheive some resemblance of stability. And as for the doc I will see him again in about two weeks. I will get the DNA tests then(was wrong they won't be being mailed to me) and will also possibly hear of what he wants to try next. So far he has tried deplin and memantine. He is an expert in the field of ocd(a lot of the ocd papers you read he most likely contributed) so hopefully he's got something up his sleeve. We shall see I guess. He mentioned something about lamictal, and seeing my side effects from ssri I think he is venturing away from that class. For now I am not on anything except for minocycline and nac. Minocycline seems to help somewhat but I'm betting it may be more placebo. Could also be the ivig therapy I am receiving, at the dose of 2g/kg once a month.
Posted by ed_uk2010 on February 12, 2015, at 15:25:18
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 12, 2015, at 15:08:22
I thought you'd tried Lamictal? Was it a long time ago and would you re-try it? Perhaps you've not taken it since childhood.
Posted by Bill82 on February 12, 2015, at 15:33:16
In reply to Re: OCD Dont know where to go, posted by ed_uk2010 on February 12, 2015, at 15:25:18
I had tried it a few months back, but had also been on it a while when I was ypunger. A few months back it made my ocd seemingly worse because I had no emotions(that's what it felt like). You could have told me my house burned down and I would have said ok, or that I had won the powerball and I wouldn't have really cared. This back door spikes my ocd because i was worried I was begining to accept the thoughts and I didn't like that I guess. Does lamictal help ocd at all? I think might have gotten somewhat agitated when going on twoards 50 75mg after titrating. I remeber getting really ticked off easily, especially at my drs. It would certainly help bipolar if I have minor bp2, but not sure about ocd. What are your thoughts on it and it's side effect to benifit ratio?
Posted by phidippus on February 12, 2015, at 15:40:37
In reply to Re: What is OCD? For those that don't know.... » Bill82, posted by ed_uk2010 on February 12, 2015, at 12:36:52
> >In accepting my obsession I feel it would ruin the ability for me to ever love again
I had an obsession with suicide for a long time. As exposure therapy, I would pretend to kill my self with a knife. To add humor to the proceedings, I would go all out, don a bandana and pretend to commit hari kari.
With proper exposure therapy you are not accepting your obsession, but rather reducing its power to cause you anxiety. As you reduce the anxiety of your obsession, your compulsions will wane.
> Her doctor advises her to try to resist the compulsive checking because it doesn't actually make her feel better
This is erroneous advise. The compulsive checking is born of the fearful thoughts she is having, therefore the focus of therapy should be on lessening the anxiety she has about the thoughts she is having. Once the fear of the thoughts is lessened, checking rituals will seem unimportant.
> So, she tries to change her thoughts. What can she possibly accept or change?
Bad move. Trying to change her thoughts is only going to cause more anxiety and increase the frequency of her thoughts. Her brain needs to be trained to have the thoughts and regard them as inconsequential. Acceptance comes when she can have the thoughts without consequence.
> How can she come to terms with the thoughts? She needs to accept that the thoughts are OCD.
This is often not enough for OCD sufferers. Many people with OCD can identify their thoughts as OCD but still experience a great deal of anxiety. The key to accepting OCD thoughts is to embrace them as a good idea.
> How can she stop the compulsive behavior?By reducing the anxiety she has about her OCD thoughts. Medication can also help.
>If the thoughts are not hurting her family, do they really matter? No. They are horrible.
What are you talking about? These are wonderful thoughts. ;)
> True, and you've not had much luck with psychological therapies so far either.To be honest, I don't think he's had proper ERP nor do I think has he committed to proper therapy
> >Although part of me thinks I am making it up and lying.....
>
> Obsessions of doubt?OCD is called the doubting disease.
One thing I wanted to mention about medication and OCD. I find that OCD sufferers have a difficult time taking medication because of side effects. It happens a lot they get strange side effects and a lot of them, which makes me wonder just how much their anxiety is playing in the genesis of these side effects.
I would like to see someone with OCD take an SSRI for 6 weeks then tell me how they feel.
Eric
Posted by Bill82 on February 12, 2015, at 16:29:24
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
I just got off vortioxetine for 4 months, I had constant drips of urine from my penis along with vocal and motst tics. My ocd was also greatly unchanged except for the ability to disengage from compulsions and space out. After stopping the medicine y tics stopped along with my dripping(mostly) and my ocd has remained mostly unchanged once again for over a month. Only thing that has changed in this time is my activity level, while starting the sSri I was still going in public, on the last month of the ssri(or seritonin modulator and reuptake inhibitor to be precise) I was where I am now where I am not leaving my house at all and pretty much sit and think all day. Similar thing happened with luvox except I experienced priapism for the first few days but decided to just push through it, as it was only partially inflated at all times) and I also had no drips then. On prozac I experienced a rash within 2 weeks covering the areas around my mouth, all over my genitals, my armpits and backs of my knees and joint of my arms along with the inability to urinate except unless I applied direct pressure to my bladder and squeezed the urine out. I also had other side effects but I ruled those out as I feel as if they have a high rate of placebo effect(ie the sexual side effects they caused along with cognitive deficits and anxiety increase) and as I said earlier I feel like I am lying a lot so I try to only complain perse of the physical ones when I see the doc(or at least the ones that I literally cannot tolerate). I also had tics on prozac and luvox and lexapro. Tics were primarily shouting mid sentance or jerking my head to the right in a certain way as if I was sneezing. I suppose I could re trial paxil but I was told by my parents I was prescribed that when young(as a dr said I had add and minor anxiety) and within days started to wash my hands for no reason compulsively. When paxil was withdrawn I stopped washing. I do agree though that in the over attentive ocd mind it is easier to imagine side effects that are not real, and for that reason I do potentially think some of mine could be that, but I don't think the tics, urination problems, priapism or decreased and flat mood I got could be attributed to them as these were all sustained for the entire duration of treatment. There is the possibility of nefazadone I guess but not sure if it's marketed anymor
Posted by Bill82 on February 12, 2015, at 16:34:43
In reply to Re: What is OCD? For those that don't know...., posted by Bill82 on February 12, 2015, at 16:29:24
Also of note, alchohal dose dependently abolishes both my compulsions and obbsessions. But as my dad was an alchoholic and I often drink way too much I refrain from drinking at all times unless I am literally going nuts(last drink was over a month ago). Alchohal also has a rebound effect in worsening my ocd gravely the next day. Alchohal to my understanding inhibits glutamate and encourages GABA in some way giving it's depressive effects. It also effects dopamine and other receptors, but it's depressive effects are primarily due to Glutamte and GABA. When on benzos I experience the same uncanny urge to take "just one more" until the bottle is gone and I wake up the next day with extreme ocd and withdrawls. However unlike alchohal when in benzos my ocd is unchanged. This has lead me to wonder about glutamate involvement, and is why I have proposed trailing some glutamatergic agents. I could be wrong but I don't see the disadvantage to this. I also beleive minocycline may have slightly helped calm some ocd, but this is most likely placebo.
Posted by ed_uk2010 on February 12, 2015, at 16:36:47
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
>To add humor to the proceedings, I would go all out, don a bandana and pretend to commit hari kari.
You certainly did go to some effort there!
>With proper exposure therapy you are not accepting your obsession, but rather reducing its power to cause you anxiety.
Yes, exactly. Accepting it isn't necessarily the right word. But you are allowing the obsession to occur, while not performing the compulsion.
>As you reduce the anxiety of your obsession, your compulsions will wane.
Indeed, once an obsession loses its power, it's no longer an obsession.
>Her brain needs to be trained to have the thoughts and regard them as inconsequential. Acceptance comes when she can have the thoughts without consequence.
Yes, that's what I mean by acceptance.
>This is often not enough for OCD sufferers. Many people with OCD can identify their thoughts as OCD but still experience a great deal of anxiety.
True. The boundaries are often blurred by doubt, however.
>The key to accepting OCD thoughts is to embrace them as a good idea.
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.
>How can she stop the compulsive behavior?
>By reducing the anxiety she has about her OCD thoughts. Medication can also help.True.
>If the thoughts are not hurting her family, do they really matter? No. They are horrible.
>
> What are you talking about? These are wonderful thoughts. ;)This is the question. Does she need to think they are wonderful as part of the exposure therapy? Can't she simply accept their occurrence as being harmless? Wonderful might be pushing it because she will never believe it.
Accepting them as harmless creations of her OCD, on the other hand, seems more achievable. If exposure to the thoughts allows her to view them as harmless, the compulsion will be easier to extinguish.
>I find that OCD sufferers have a difficult time taking medication because of side effects. It happens a lot they get strange side effects and a lot of them, which makes me wonder just how much their anxiety is playing in the genesis of these side effects.
Yes, I agree and this is an issue in other types of anxiety too. Panic disorder pts tend to be most sensitive to ADs because any different/unusual bodily sensations are interpreted as being the start of a panic attack.
Thanks for your post.
Posted by ed_uk2010 on February 12, 2015, at 16:53:22
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 12, 2015, at 15:33:16
Hi again!
RE. Lamotrigine.
>I had tried it a few months back, but had also been on it a while when I was younger. A few months back it made my ocd seemingly worse because I had no emotions(that's what it felt like).
How long did you try it for? Were you still on vortioxetine? I ask because you took it when you were younger, and you didn't mention experiencing emotional blunting then, or did you? Emotional blunting is so much more typical of serotonergics (SSRIs, vortioxetine etc) than lamotrigine.
>Does lamictal help ocd at all?
It's not a well established treatment for OCD, but you're currently trying more experimental meds anyway. Except in those who are allergic (a minority, and not you!), Lamictal is generally a safe medication.
Posted by ed_uk2010 on February 12, 2015, at 17:09:00
In reply to Re: What is OCD? For those that don't know...., posted by Bill82 on February 12, 2015, at 16:34:43
>Also of note, alcohol dose dependently abolishes both my compulsions and obsessions. But as my dad was an alchoholic and I often drink way too much I refrain from drinking at all times unless I am literally going nuts(last drink was over a month ago).
The thing about alcohol is that it's such a broad spectrum CNS depressant and euphoriant, it dose-dependently abolishes most things!
>Alcohol also has a rebound effect in worsening my ocd gravely the next day.
That's a major sign you should avoid it. Drinking regularly would no doubt lead to severe dependence.
>Alchohal to my understanding inhibits glutamate and encourages GABA in some way giving it's depressive effects. It also effects dopamine and other receptors, but it's depressive effects are primarily due to Glutamte and GABA.
True.
>When on benzos I experience the same uncanny urge to take "just one more" until the bottle is gone and I wake up the next day with extreme ocd and withdrawals.
This is a feature of the disinhibition the drugs cause.
>I could be wrong but I don't see the disadvantage to this.
It's all rather experimental, but there are other meds you could try eg. the antiepileptic oxcarbazepine (Trileptal). It's effective in animal models of OCD, plus there's the occasional case report.
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?
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