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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Chris2011 on April 21, 2011, at 14:16:44
I have multiple mental health conditions that have been affecting my life for years now (OCD, social anxiety disorder, depression, mild paranoia) and I have not taken medication(s) mainly due to my OCD obsessions about the meds and partly because of not being able to tolerate the side-effects. I'd go into detail about the obsessive thinking about the meds but it's difficult to explain and wouldn't make much sense. In short, I have obsessions about the neurotransmitters that a certain med might affect and if I take a med and I'm not sure if certain neurotransmitters are being increased/decreased then my thoughts are interrupted when I interact with others. I'm pretty certain this is the OCD and social anxiety interacting and .....
Anyway, I'm at the point of desperation and I don't care about the OCD fears about the medications anymore. I just want to take a med and stick with it for a month or so. Something I've been so fearful of for literally 10+ years due to OCD fears. I've been on Lexapro 2.5mg and klonopin .25mg 4x's a day for the past 3 years, which has sort of stabilized me but I'm still barely treading water. The only other meds I have been able to give an adequate trial are Paxil, all the the Benzos, all the natural supplements, and Anafranil. All of which I couldn't tolerate. The Anafranil did help with OCD but I couldn't tolerate the apathy and somnolence that came along with it. I tried Parnate on a few occasions but only for a day or two. This is the one med I feel would help me significantly as it would address my severe social anxiety and OCD. I know it's not usually prescribed for OCD but I've read several posts on this site from OCD/social anxiety sufferers who have benefitted from Parnate. My main concern is that I don't think I can handle the increased anxiety from the med in the first few weeks of taking it. My anxiety is already bad enough and from past med trials, the increased anxiety has always resulted in embarassing social interactions which then causes me to quit taking the med.
From brief trials of other meds of all classes, and from the extensive internet research I've done on meds, the only other meds I will try are Anafranil (again) and Abilify (for the mild paranoia and to see if my social anxiety is actually a form of psychosis - My social anxiety is a feeling of being watched and criticized/judged when speaking to others). I've already tried to increase the Lexapro dose to a "therapeutic" level (15mgs for 6 weeks) but it didn't make any difference. I know that agonizing about which medication(s) to take is part of my OCD perfectionism. I also know that meds might not even be the answer and that there is a lot to be said for cognitive therapy, exposure, exercise, etc. Especially CBT and exposure for the social anxiety. If you're reading this you can probably sense my extreme frustration in trying to figure out the perfect answers to my problems, which is why I'm posting on this message board that I've been reading for years but never thought to post and ask for help and advice.
If anybody out there has any ideas, advice, insights, please let me know. I'm sure I'm missing something. Paralysis from analysis I guess. I need to get my life on track. Thanks for reading and thanks in advance for any responses.
Posted by wilyee on April 25, 2011, at 18:42:38
In reply to Need to figure out meds to take for SA and OCD, posted by Chris2011 on April 21, 2011, at 14:16:44
Ive found nothing for ocd myself either,but elimnated totaly ANXIETY.
I use a combo of gabpentin,klonopin,and mebicar.
If you cant get the first two.mebicar is a real benzo,new,non us,that has no sedation,lil drug interaction and can legal be ordered online with a google ORDER MEBICAR search,costs about 15 bucks.
Posted by Questionmark on May 14, 2011, at 23:53:15
In reply to Need to figure out meds to take for SA and OCD, posted by Chris2011 on April 21, 2011, at 14:16:44
i know all about OCD perfectionism. And SA. What a paralyzing curse to have one, let alone both.
i understand why you're struggling w the medication decision. i have been stressing about it for a long time (whether i should go off my med, etc.).
i don't know if you need medication or if psychotherapy would be sufficient, at least with what you're on now. If you think there is a decent chance it could be sufficient, then you should probably try that first.
However, I hate to recommend medication when not needed, but it does sound like it may be in your best interests to go farther down the medication route.
I hate -- hATE -- the side effects, the potential long-term physical effects, the stress over the confusion of who is my "true" self, and other things, that my medication brings. But when i look back on the last decade, the best periods were when i was on a full dose of my med.
If you are going to go the medication route, i recommend the same drug that i use and have found to be bar-none the best: Nardil. I tried Parnate before Nardil, and the difference was night and day. Nardil was far better for my anxiety and fear, far better for my depression, and far ... less bad, for my OCD/perfectionism.
One thought:
For me, SSRIs were grossly inadequate. Sure they help a little with OCD, but it's because you care so much less about EVERYthing. Your ability to feel pleasure is also greatly diminished. And it was only moderately helpful for my anxiety and depression. ... So, for me, SSRIs did not cut it (nor any of the augmenting attempts). That said, if you think a full dose of Lexapro might be helpful for you, then try that.
Otherwise, my suggestion would be Nardil.Nardil is a miracle drug for depression. Literally. A miracle within a pill.
It is a miracle for SA -- though it leaves something to be desired compared to its antidepressive effects. Not perfect, but miraculously helpful.
Unfortunately, it is Not very helpful for OCD. It helps with a lot of the negative ruminating associated with depression, but not much more. In fact, in some ways my compulsive perfectionism is much worse-- though my assumption is it is not a direct result of the drug, but a result of being less depressed and having the ability to care about things more.
So/But, if you DO go on Nardil, or any other drug for that matter, get good therapy. It is imperative. Your OCD will not improve, and the other stuff will only be better with the drug. If you don't get therapy as well. Don't be like me and procrastinate this year after year.
I hope this was helpful. Good luck.
PS Oh and if you ever happen to find any really good therapists or programs/ what have you on the east coast, please let me know. I am desperately searching.
> I have multiple mental health conditions that have been affecting my life for years now (OCD, social anxiety disorder, depression, mild paranoia) and I have not taken medication(s) mainly due to my OCD obsessions about the meds and partly because of not being able to tolerate the side-effects. I'd go into detail about the obsessive thinking about the meds but it's difficult to explain and wouldn't make much sense. In short, I have obsessions about the neurotransmitters that a certain med might affect and if I take a med and I'm not sure if certain neurotransmitters are being increased/decreased then my thoughts are interrupted when I interact with others. I'm pretty certain this is the OCD and social anxiety interacting and .....
>
> Anyway, I'm at the point of desperation and I don't care about the OCD fears about the medications anymore. I just want to take a med and stick with it for a month or so. Something I've been so fearful of for literally 10+ years due to OCD fears. I've been on Lexapro 2.5mg and klonopin .25mg 4x's a day for the past 3 years, which has sort of stabilized me but I'm still barely treading water. The only other meds I have been able to give an adequate trial are Paxil, all the the Benzos, all the natural supplements, and Anafranil. All of which I couldn't tolerate. The Anafranil did help with OCD but I couldn't tolerate the apathy and somnolence that came along with it. I tried Parnate on a few occasions but only for a day or two. This is the one med I feel would help me significantly as it would address my severe social anxiety and OCD. I know it's not usually prescribed for OCD but I've read several posts on this site from OCD/social anxiety sufferers who have benefitted from Parnate. My main concern is that I don't think I can handle the increased anxiety from the med in the first few weeks of taking it. My anxiety is already bad enough and from past med trials, the increased anxiety has always resulted in embarassing social interactions which then causes me to quit taking the med.
>
> From brief trials of other meds of all classes, and from the extensive internet research I've done on meds, the only other meds I will try are Anafranil (again) and Abilify (for the mild paranoia and to see if my social anxiety is actually a form of psychosis - My social anxiety is a feeling of being watched and criticized/judged when speaking to others). I've already tried to increase the Lexapro dose to a "therapeutic" level (15mgs for 6 weeks) but it didn't make any difference. I know that agonizing about which medication(s) to take is part of my OCD perfectionism. I also know that meds might not even be the answer and that there is a lot to be said for cognitive therapy, exposure, exercise, etc. Especially CBT and exposure for the social anxiety. If you're reading this you can probably sense my extreme frustration in trying to figure out the perfect answers to my problems, which is why I'm posting on this message board that I've been reading for years but never thought to post and ask for help and advice.
>
> If anybody out there has any ideas, advice, insights, please let me know. I'm sure I'm missing something. Paralysis from analysis I guess. I need to get my life on track. Thanks for reading and thanks in advance for any responses.
Posted by Questionmark on May 15, 2011, at 0:01:58
In reply to Re: Need to figure out meds to take for SA and OCD, posted by Questionmark on May 14, 2011, at 23:53:15
PPS...
"Paralysis from analysis."
That's great.I don't think there's a better trio of words to accurately describe my life.
Posted by desolationrower on June 5, 2011, at 16:59:23
In reply to Need to figure out meds to take for SA and OCD, posted by Chris2011 on April 21, 2011, at 14:16:44
have you tried any drugs that act on the glutamatergic system?
-d/r
Posted by Chairman_MAO on October 13, 2011, at 23:03:45
In reply to Need to figure out meds to take for SA and OCD, posted by Chris2011 on April 21, 2011, at 14:16:44
Time to try something new:
1. J Clin Psychiatry. 2005 Mar;66(3):353-9.Double-blind treatment with oral morphine in treatment-resistant
obsessive-compulsive disorder.Koran LM, Aboujaoude E, Bullock KD, Franz B, Gamel N, Elliott M.
Department of Psychiatry and Behavioral Sciences, Stanford University Medical
Center, Stanford, CA 94305, USA. [email protected]BACKGROUND: Obsessive-compulsive disorder (OCD) often responds inadequately to
serotonin reuptake inhibitors (SRIs). A case series reported substantial response
to once-weekly oral morphine. We conducted a placebo-controlled, double-blind
trial to investigate whether once-weekly oral morphine is effective in
SRI-resistant OCD.
METHOD: Subjects with DSM-IV-defined OCD for > or =3 years who had failed > or =2
adequate SRI trials and had a Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
score of > or =20 were recruited. Current medications were continued. Subjects
were randomly assigned to random-order, 2-week blocks of once-weekly morphine,
lorazepam, and placebo. Week 2 dosage was increased, decreased, or maintained
depending on response and side effects.
RESULTS: We enrolled 23 subjects, who had failed 2 to 6 SRI trials. The median
screening Y-BOCS score was 29. The median Y-BOCS score after morphine (highest
dose) was 25 (median decrease = 13%). Seven subjects (30%) were responders
(Y-BOCS decreases > or =25%). The median Y-BOCS score after lorazepam (highest
dose) was 27 (median decrease = 6%). Four subjects (17%) responded to lorazepam;
1 was a morphine responder. The median Y-BOCS score after placebo (highest dose)
was 27 (median decrease = 7%), and no subject responded. Responses differed
significantly among the 3 conditions (Friedman 2-way analysis of variance,
chir(2) = 13.92, df = 2, p = .01). Wilcoxon matched-pairs signed-rank tests (T =
56.5, p = .05) showed significance for morphine versus placebo but not lorazepam
versus placebo.
CONCLUSION: Our results support the hypothesis that once-weekly oral morphine can
reduce symptoms in some treatment-resistant OCD patients. The mechanism of action
is unknown. Further studies of mu-agonists and glutamate antagonists are
warranted.
PMID: 15766302 [PubMed - indexed for MEDLINE]
Posted by phidippus on September 29, 2012, at 17:11:37
In reply to Need to figure out meds to take for SA and OCD, posted by Chris2011 on April 21, 2011, at 14:16:44
>I have not taken medication(s) mainly due to my OCD obsessions about the meds and partly because of not being able to tolerate the side-effects.
If you take a medication long enough, you will find most of the side effects will go away
>I'd go into detail about the obsessive thinking about the meds but it's difficult to explain and wouldn't make much sense.
Tell me what intrusive thoughts you have about the medication
>I just want to take a med and stick with it for a month or so.
With OCD, you need too try on a medication for at least two months.
>I've been on Lexapro 2.5mg and klonopin .25mg 4x's a day for the past 3 years, which has sort of stabilized me
2.5 mg of Lexapro is doing nothing for you. For OCD Lexapro should be prescribed at a 40 mg dose. Your Klonopin is at an extremely low dose as well.
>I tried Parnate on a few occasions but only for a day or two. This is the one med I feel would help me significantly as it would address my
severe social anxiety and OCD.Parnate will not treat your OCD. There is very little literature about MAOIs being efficacious in the treatment of OCD.
>My main concern is that I don't think I can handle the increased anxiety from the med in the first few weeks of taking it.
What amount of anxiety will you deal with in order to get better?
> From brief trials of other meds of all classes, and from the extensive internet research I've done on meds, the only other meds I will try are Anafranil (again) and AbilifyLuvox, Paxil, Prozac, Zoloft are all approved to treat OCD. Plenty of studies back up these drugs.
Cymbalta,Effexor, Pristiq, Mirtazapine, Lexapro, Celexa and Anafranil are all medications studied in the treatment of OCD.
after you've been on an antiobsessional for a couple months and you're still having issues, the APA recommends the addition of an antipsychotic
>(for the mild paranoia and to see if my social anxiety is actually a form of psychosis
Trust me, you're paranoid, but not psychotic. OCD can play tricks on you.
>I've already tried to increase the Lexapro dose to a "therapeutic" level (15mgs for 6 weeks)
Try 40 mg
>I also know that meds might not even be the >answer and that there is a lot to be said for >cognitive therapy, exposure, exercise, etc. >Especially CBT and exposure for the social >anxiety.
ERP, ACT and CBT will bbe invaluable tools for you
If you're reading this you can probably sense my extreme frustration in trying to figure out the perfect answers to my problems,
There are no perfect answers to your problems
>
> If anybody out there has any ideas, advice, insights, please let me know.I have plenty of ideas, I am a fellow OCD sufferer. In the 13 years I've had this disease I have had experience with many drugs and many therapies.
Eric
This is the end of the thread.
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