Posted by g_g_g_unit on July 27, 2012, at 7:51:14
In reply to Re: Parnate decision » g_g_g_unit, posted by phidippus on July 26, 2012, at 22:24:11
> MAOIs are reccommended as a last line of treatment according to the APA treatment algorithm for OCD. Parnate is not working for you and its time to give it up.
>
> According to the APA treatment algorithm for OCD, the first line of treatment medicine wise is an SSRI. If you fail to respond to the SSRI or there is only moderate improvement, the APA recommends augmentation with an atypical antipsychotic.
>
> The logic is thus: in patients with OCD it has been shown that there are deficiencies in seratonin in the prefrontal cortex-glutamate levels are also too high. Treatment with an SSRI boosts deficient levels of seratonin and corrects the imbalance. It doesn't stop there though. It has also been shown that folk with OCD have elevated levels of dopamine in the nucleus acumbens. Augmentation with an atypical antipsychotic corrects this imbalance.
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> I have OCD and am doing great, mostly due to the fact I follow th APA guidelines for the treatment of OCD. My meds are:
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> Viibryd 60 mg
> Lithium 1200 mg
> Abilify 10 mg
> Klonopin 2 mg
>
> Try the formula. Get on an SSRI at a therapeutic level, then augment with an atypical antipsychotic. Parnate is just the wrong choice.
>
> EricNot everyone has to live within the APA guidelines. I know a girl who's had severe OCD since she was 8. Despite being tried on SSRIs, anti-psychotics, etc., she was unable to complete high school and now, at 23, remains at home. She's chosen to combine Dexamphetamine with a mindfulness approach, because she finds SSRIs mentally dulling and not worth the trade-off.
Likewise, SSRIs are anathema to me and I have a sensitivity which prevents me from tolerating high doses of medication anyway. I've tried clomipramine, Seroquel, Zyprexa and none agreed with me. A stimulant with a benzo basically got rid of my obsessive thoughts, but took away most of my other thoughts too.
My doctor has agreed to try Memantine in combination with Dexamphetamine. If that doesn't provide sufficient anxiety control, I'd add in a low-dose of an SSRI and/or a benzo and deal with any remaining symptoms in therapy.
I'm trying to find a combination that will accord with my own personal values and ambitions. The APA can't account for that, nor can it account for things like metabolic aberrations. If that doesn't work out, and my life was at stake, then I'd turn to a high-dose SSRI or Nardil. But right now, I'm still exercising my freedom to explore.
poster:g_g_g_unit
thread:1021887
URL: http://www.dr-bob.org/babble/20120718/msgs/1022212.html