Posted by phidippus on November 4, 2012, at 1:06:48
In reply to Re: OCD » phidippus, posted by brynb on November 4, 2012, at 1:16:40
>constant guilt (over things I've done/said/think/feel)
This is more a symptom of depression.
>reading something over and over again, constantly organizing things and lining them up in my medicine cabinet and around my apartment, checking the lock on my door again and again, repeating things in my head and out loud to people, and the worst--ugh--picking my scalp.
You have OCD. Picking of the scalp is referred to as trichotillomania.
>My pdoc mentioned that if we're going to look at my Dx as bipolar (he's not certain what my Dx is yet), he wants to lower my Lexapro dose once my depression is better.
This strikes me as a very bad idea. I don't think you are bipolar. Now that you've opened up, I'm pretty confident you are struggling with depression and OCD. Lowering your Lexapro dose will worsen your symptoms.
Please talk to your doctor about the checking and the trichotillomania. This will cement a diagnosis of OCD and give your doctor direction.
>Maybe I need a different AD (it just can't touch dopamine or norepinephrine)
I think you might want to try another SSRI, Mirtazapine or Clomipramine.
Most of the SSRIs are serotonin selective and do not inhibit the reuptake of norepenephrine or dopamine. Sertraline is the only exception I know of as it is a dopamine reuptake inhibitor. That leaves plenty of SSRIs to choose from: Prozac, Paxil, Viibryd, Luvox and Celexa.
>I was on Invega, and I had a positive response to it.
This is a good sign. I'm thinking the right AD combined with Invega might be all you need.
Remember, if you don't have a full response to an AD, augmentation with an AP could be the ticket. If you don't like the idea of being on an AP, you can always try Topomax or Lyrica.
>It would be nice to just take one little magic pill that solved everything!
If all we are dealing with is OCD and depression, you might only need one pill-the Lexapro or another AD. If I were your doctor, I would stop everything except the Lexapro, bump it up to 40 mg and see what happens. If you become manic, which I doubt you will, then we can solidify a dx of bipolar with OCD. If your symptoms improve, both depressive and obsessive then we're in the right ballpark.
What happens if you become manic? Well, just start the lithium back up, but you'll need a higher dose to balance out the AD. Hopefully you won't panic and mistake your anxiety symptoms for mania.
If the OCD symptoms don't diminish, then you can try another AD (I'd start with Luvox-its OCD specific) or you can add Invega or you can try Topomax, Keppra or Lyrica. You have a lot of choices, but (this is important) stay on your AD-it is the first weapon against OCD.
Eric
ps. Did you know that Tramadol is used to treat OCD? It makes a lot of sense to me now that you responded well to it.
poster:phidippus
thread:1030493
URL: http://www.dr-bob.org/babble/20121029/msgs/1030635.html