Posted by yxibow on December 4, 2006, at 19:26:46
In reply to Re: OCD help, posted by Kimbersaur on December 3, 2006, at 18:59:25
> > along my path in looking for a solution to the OCD disorder that I have, the best solutions to such disorder has pretty much been Lexapro....I take it at around 5 mgs, and take a 3 mg dose of Gabitril as well (which helps with some irritability issues I get from the Adderall that I take).
> >
> > My experience with Lamictal is that it made my OCD so much worse when I was on an nor-epinephrine reuptake inhibitor or a dopamine agonist (really bad days). The reason for this probably lies in Lamictal's indirect effects on dopamine release (as it pretty much takes the glutamate out of the picture, this could be one cause). So if I were in your shoes I'd probably rule out any of the TCAs (as they are both serotonin and nor-epinephrine reuptake inhibitors), as well as Cymbalta (as it is a potent SNRI as well).
> >
> > A low dose of an SSRI wouldn't hurt to try...
>
> Gosh, it feels like there is no solution. Effexor actually helped me with my OCD while I was on Lamictal, I just couldn't tolerate the anorgasmia anymore. My mom just brought me home some samples of Cymbalta and I just can't decide if I want to try it or not.
Venlafaxine (Effexor) works a little differently and I think has been challenged against OCD. I currently take Cymbalta and it does cover my secondary depression but doesn't do a lot for obsessional/garbage-racist-spaghetti thoughts (not my personality, just nonsense in the mind -- actually the more you try to fight them the worse it is so I just let it float away.)
There's no harm in trying Cymbalta though I probably would start at a low dose of it to see if you are one of the people who can stand Effexor but not Cymbalta. (I'm the opposite, I think, though I also take benzodiazepines.) Cymbalta is a very subtle agent in my experience and can take a while for that "oh, its working" feeling. But as they say, your miles may vary.
Tricyclics do carry a burden of somewhat higher toxicity, but we're not talking barbiturate type issues. They can, on rare occasion, cause TD though that is not a common incident. Mainly they are more sedating, and less "clean" than SSRIs and do activate more than one transmitter and are more sedating. This sedation is part of the issue of extra toxicity since (and I'm not going to go there on this board, but you can guess that increases risks). They're generally antihistamines. They still have their use in modern psychiatry though they've been around for probably at least 30 years.
If Effexor really worked for you, you could discuss with your doctor about low dose Wellbutrin SR/XL augmentation for the sexual side effects.If an agent works well, I would go for it, but I know that sexual side effects can be as depressing as the agents we try to fight our problems with.
Its a tradeoff at times, and the side effects vary -- low dose SSRIs are actually used for people who have orgasmic experiences too fast, ironically.
Desvenlafaxine may be coming out in the next year, the metabolite of Effexor, yes, most likely just a patent extender, but who knows what it might do for Effexor takers.
Ultimately OCD help relies both on medication and behavioural therapy, though obsessive thinking is one of the harder ones to overcome.I assume you know about the OC Foundation, but have a look at their website if you dont, its a good stepping off place
www.ocfoundation.org
-- tidings
Jay
poster:yxibow
thread:709854
URL: http://www.dr-bob.org/babble/20061129/msgs/710411.html