Posted by yxibow on March 22, 2007, at 3:19:18
In reply to Re: How Do I Know If I Have OCD? » yxibow, posted by johnnyj on March 21, 2007, at 20:14:03
> I am thinking of a trial with anafranil if things don't improve. Have you ever tried it? I have heard it's one of the best and the side effects seem to be unclear. I have heard it really is not that bad, to it is terrible.
I haven't tried it -- it is the "gold standard" for hard to treat OCD. It could be called an SRI. Clomipramine has typical side effects for a TCA, sweating, fatigue, dizziness, etc., anticholinergic effects, as well as possibility of EPS though you may or may not experience any or some of these.
> Ssri's just cause too much akathisia for me. Maybe, and thats a big maybe, I could stay on a dose of 12.5 of luvox, just can't tolerate anymore than that. Since luvox at 25, and paxil at 5 caused major problems I wonder if all ssri's won't work for me? My BIGGEST problem is with sleep and songs that won't leave my head. The songs are something new about 5 months ago after going off all meds. Right now I may have to do with Remeron. Adjusting to the dose is rough though.
Songs that don't leave one's head for a period of time is a common condition and isn't necessarily a sign of OCD. However the level of distress sounds like it could be for you.Problems with sleep are not necessarily an issue of OCD unless pure obsessions keep you up at night. (I have had that before.)
Have you had a sleep study before ? Are there any other possible conditions such as sleep apnea (and obesity) that may contribute to less than satisfactory sleep? Have you tried all the standard sleep medications out there as well as ones used for their side effects (a small dose of Remeron may improve REM sleep).
It is unfortunate that SSRIs cause akathisia to this extent. It is certainly possible, and I know it is a unpleasant state to be in. Luvox really is one of the best SSRIs for OCD in my opinion but one needs to be at a level of 200-400 mg to have an effect. 12.5mg of Luvox is a placebo for most people but I grant that you are sensitive to SSRIs. Are you positive that this is not initial agitation as SSRIs can broadly cause this? I assume you have tried most all SSRIs and would not like to try others. Generally newer SSRIs are more targeted and have less unintended transmitter effects but this is not always the case.
Remeron is a very good antidepressant; I don't know if it has been challenged much for OCD. There was one small double blind study from what I can see. It carries a burden of increased weight, largely through increased appetite though this of course is not completely settled. Higher doses rarely change this effect unlike some predictions of transmitter offset.
> Benzo's are out too. Cause depression.Some benzodiazepines can cause depression as they are CNS depressants like alcohol. Not a primary drug for OCD though, usually used as a secondary (e.g. clonazepam), especially as a secondary for SSRIs and to reduce anxiety during CBT.
> Do you have any idea about the best clinics out there for OCD?
Well the best place to start is the OC Foundation, as mentioned, http://www.ocfoundation.org/
On the site there is a compilation of interviews with people associated with intensive treatment programs for OCD
http://www.ocfoundation.org/ocd-intensive-treatment-programs.html
I happened to know vaguely about one of these clinics but I cannot say for my privacy. However, I can say that the OC Foundation is among the premier sources of information for OCD.
> thank you
>
> johnnyj
poster:yxibow
thread:742798
URL: http://www.dr-bob.org/babble/20070320/msgs/743102.html