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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on February 21, 2015, at 7:37:53
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by phidippus on February 20, 2015, at 15:06:06
> My sexual functioning is unaffected by the Fluvoxamine.
>
> Fluvoxamine does not affect my cognition, memory or ability to reason. If anything my memory is improved-and since I'm not overwhelmed by obsessions, I would say my cognition is better as well.
>
> I've had no loss of energy while on Fluvoxamine and no weight gain either.
>
> I was on 900 mg of Lithium,240 mg of Geodon, 70 mg of Vyvanse and 100 mg of Fluvoxamine when my OCD just disappeared.Gosh! That's terrific!
- Scott
Posted by Bill82 on February 24, 2015, at 13:37:53
In reply to Re: Neurobiology of OCD - speculation, posted by SLS on February 21, 2015, at 7:37:53
Got my genetic testing back some interesting stuff. Was prescribed lamotragine so we will see how that goes. Worried about memory or libido problems but have told myself I will just white knuckle it until he says to stop, unless of course I have serious side effects such as steven johnson rash or other allergic reactions. Anyways check out the results and if you have any hhoughts post them I'd love to hear.
SLC6A4- result-L(A)/L(G)
Serotonin Transporter-patient exhibits a mutation of the serotonin transporter associated with reduced reuptake of seritonin, less satisfactory response to ssri, and a potentially greater risk for adverse effects from ssri. This variant has also been associated in literature with lower stress resilience and higher rates of PTSD.
5ht2c -Serotonin Receptor result- C/C
Serotonin has potent satiety signaling activity and 5ht2c antagonism has been shown to lead to increased food intake. This patient exhibits a variant of the 5ht2c receptor which has been associated with satiety in the hypothalamus.
CACNA1C Calcium Channel-result G/A
The patient exhibits a variant in the gene coding for a subunit L-type voltage gated calcium channel. Days regulation of this channel has been associated with changes in neuronal depolarization, amygdala volume in schizophrenics and bipolar patients, frontal hippocampus connectivity, disruptions in cognition in both schizophrenic and bipolar patients, and has been hypothesized to be related to glutamate signaling. Clinically has been associated with conditions charecteriEd by mood instability or lability.
Mtfhr-impared folic acid metabolism and blunted activation in the anterior cingulate.
CYP2D6 - cytochrome P450 2D6- result - intermediate metabolizer
Reduced hepatic degradation and higher plasma levels of flouxetine fluvoxamine paroxatine sertraline duloxetine venlafaxine mirtazipine nefazadone apriprazole haloperidol iloperidone risperidone atomoxetine amphetamine-dextrothetamine methamphetamine olanzapine codeine methadone tramadol vortioxetine TCA's phenothiazines
CPY2C19 Cytochrome p450 2C19- result - ultra rapid metabolizer
Poorer efficiency and reduced plasma levels of citalopram escitalopram diazepam clomipramine imipramine trimipramine
Posted by phidippus on February 24, 2015, at 15:36:53
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 24, 2015, at 13:37:53
>Was prescribed lamotragine so we will see how that goes. Worried about memory or libido problems
Lamictal may affect your memory, however I doubt it will affect your libido.
Explain to me why you are afraid drugs will affect your libido.
>reduced reuptake of seritonin, less satisfactory response to ssri, and a potentially greater risk for adverse effects from ssri.
this explains a lot and all around sucks.
Have you ever been on Mirtazapine?
Eric
Posted by Bill82 on February 24, 2015, at 15:54:53
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by phidippus on February 24, 2015, at 15:36:53
I don't really know to be honest, one of my first obbsessions was that a girl I was talking to and really liked/got along with was starting to get closer to me, and as I was a virgin at the time I was worried of becoming either impotent or uninterested in here in the future and then losing her. Weird as hell but it's just an older obsession I guess so I worry about it. Do you say lamictal May effect memory from personal experience or from studies. My memory is already partly messed up so for it to get worse would suck, but if it helps I'm willing to try it. I wonder if the biaxin or minocycline could be behind some of my current memory issues.
Posted by Bill82 on February 24, 2015, at 15:57:25
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by phidippus on February 24, 2015, at 15:36:53
Also yes and I had to discontinue due to rage/extreme appitite and gaining 20lbs in the span of 2 weeks
Posted by phidippus on February 24, 2015, at 17:02:11
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 24, 2015, at 15:54:53
>I wonder if the biaxin or minocycline could be behind some of my current memory issues.
According to studies, minocycline improves memory.
Why are you taking Biaxin?
>Do you say lamictal May effect memory from personal experience or from studies.
About 3% of Lamictal users will experience some form of memory impairment. There are a lot of case reports on the web and I experienced it myself.
Eric
Posted by phidippus on February 24, 2015, at 17:05:20
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 24, 2015, at 15:57:25
You really need serotogenic therapy. Have you tried Effexor? According to the algorithm for the treatment of ocd put out by the APA, Effexor is recommended when ssris fail.
Eric
Posted by Bill82 on February 24, 2015, at 17:06:56
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by phidippus on February 24, 2015, at 17:02:11
I tested positive for borellia, bartonella, babes is and still have very high levels of igg for mycoplasma p. So I figured why not cover all the bases as I'm desperate and try antibiotics for those. And that's to bad, I presume it was short term memory?
Posted by phidippus on February 24, 2015, at 17:08:12
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 24, 2015, at 15:57:25
http://www.aafp.org/afp/2008/0701/p131.html - here's APA treatment algorithm.
Have you been on an MAOI?
Eric
Posted by phidippus on February 24, 2015, at 17:13:13
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 24, 2015, at 17:06:56
While your on the antibiotic tip, you should read up on D-cycloserine.
Also, I bet Keppra would be more effective for your OCD than Lamictal.
Eric
Posted by phidippus on February 24, 2015, at 17:14:05
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 24, 2015, at 17:06:56
>I presume it was short term memory?
Yes sir.
Eric
Posted by Bill82 on February 24, 2015, at 17:25:52
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by phidippus on February 24, 2015, at 17:08:12
No havnt tried a maoi, looked at parnate a little but the insomnia seemed intense. And as for effexor I have heard too many horror stories about that, and my experiences with douloxetine was awful, extreme exacerbation in tics and near paralyzing anxiety/ocd thoughts. Other than ssri which the DNA test said don't look to promising there's really only mirtazipine nefazadone trazadone and then ones not approved by the fda I would have to order without a prescription. And none of those seem to do much for ocd that I know of.
I have heard of keppra, what makes you think it would be better? From what I have read it can induce anxiety/irratibility quite commonly.
Have wondered about d cycloserine, have not been able to find any reviews of it so have never really gotten the desire to peruse it, and most docs don't know about it.
Posted by phidippus on February 24, 2015, at 17:42:45
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 24, 2015, at 17:25:52
>looked at parnate a little but the insomnia seemed intense
Nardil is the only MAOI I've read substantive stuff on regarding OCD.
>I have heard of keppra, what makes you think it would be better? From what I have read it can induce anxiety/irratibility quite commonly.
I've taken it and it nearly obliterated my anxiety. Stanford did a study but they haven't published the results yet. Its a powerful glutamate antagonist(much more powerful than Lamictal) and yes it CAN cause anxiety as a side effect and Keppra rage is infamous but usually easily treated with B6 supplements.
Maybe Tramadol might work for you.
Eric
Posted by Bill82 on February 24, 2015, at 17:49:22
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by phidippus on February 24, 2015, at 17:42:45
That's neat I was actually thinking of pursuing keppra but was put off by the rage aspect. Did it help your ocd? What about the sexual s/e or memory cognition effects? And yea nardil is a thought, would reap havoc on my ocd though with it's side effects haha. Wonder if it would have more of an effect than ssri due to it's different moa.
Posted by phidippus on February 24, 2015, at 18:12:08
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 24, 2015, at 17:49:22
>Did it help your ocd? What about the sexual s/e or memory cognition effects?
Keppra helped my OCD immensely - it short circuited the anxiety the OCD caused. I would have an OCD thought and would have no anxiety about the thought. I would still be taking it but I don't need it since starting the Luvox.
I had no side effects from the Keppra.
>Wonder if it would have more of an effect than ssri due to it's different moa.
MAOIs are not tried and tested when it comes to treating OCD. I don't know if it would be more effective than an SSRI.
REALLY...Try Tramadol.
Eric
Posted by Bill82 on February 24, 2015, at 19:59:25
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by phidippus on February 24, 2015, at 18:12:08
Yea I tried to order it once but caught the guys in the act scamming our card, and I think it just became a narcotic in the USA so you can't anymore, not sure if I could get it prescribed anymore, looks really good though, I know when I had morphine for menningitis in the hospital my ocd vanished. And as for maoi's I wonder for me, since my sert transporters are already not very active, if decreasing the rate of te breakdown of serotonin would effect my ocd more than blocking an already blocked sert.
Posted by phidippus on February 25, 2015, at 11:12:16
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 24, 2015, at 19:59:25
Tramadol is terrific for OCD as it works in three different fashions which are beneficial in treating OCD. It is an NMDA antagonist. It is an opiate and it is a weak SNRI. It worked for me as monotherapy.
I don't think your SERT is blocked already. What makes you think that?
Eric
Posted by Bill82 on February 25, 2015, at 11:50:01
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by phidippus on February 25, 2015, at 11:12:16
Not that it's blacked, but my genetic testing showed it's already under active, enough so that it's a gene associated with low responses to ssris. Which would also mean theoretically I may have more seritonin than usual and that seritonin isn't the main problem. I have heard of people getting addicted to tramadol, and that it only helps ocd for a little while then tolerance builds like most opiates, slightly worrying, but nonetheless still an option
Posted by phidippus on February 25, 2015, at 16:58:31
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 25, 2015, at 11:50:01
>Which would also mean theoretically I may have more seritonin
If you have OCD, you certainly don't have 'more' serotonin.
>I have heard of people getting addicted to tramadol
This puzzles me, because Tramadol is about as strong as codeine, which is not commonly abused. Also, the mechanism of action most likely to be helping with the OCD is its SNRI properties.
Eric
Posted by ed_uk2010 on February 25, 2015, at 18:50:53
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 25, 2015, at 11:50:01
>Not that it's blocked, but my genetic testing showed it's already under active, enough so that it's a gene associated with low responses to ssris. Which would also mean theoretically I may have more seritonin than usual and that seritonin isn't the main problem.
If your brain has developed from birth with an underactive serotonin reuptake system, it may have adapted to this in some way, perhaps by reducing serotonin release or receptor sensitivity.
>I have heard of people getting addicted to tramadol, and that it only helps ocd for a little while then tolerance builds like most opiates
It has a high potential for physical dependence and withdrawal symptoms. It was originally introduced as a med with little risk of dependence, and doctors prescribed it widely. Unfortunately, the dependence risk had been underestimated. It has recently been made a controlled drug over here. Given your issues with opiates in the past, it cannot really be recommended for you.
Posted by Bill82 on February 26, 2015, at 14:16:23
In reply to Re: Neurobiology of OCD - speculation » Bill82, posted by ed_uk2010 on February 25, 2015, at 18:50:53
Is it normal to become very irritable/ angry on this med? I seem to get extremly annoyed / mad at anything and have urges to just break things out of annoyance/irritability.
Posted by ed_uk2010 on February 26, 2015, at 16:48:17
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 26, 2015, at 14:16:23
>Is it normal to become very irritable/ angry on this med?
On Lamictal? Most people do not experience that, but I have certainly heard of it before.
Posted by Hugh on March 3, 2015, at 13:00:00
In reply to Re: Neurobiology of OCD - speculation, posted by Bill82 on February 26, 2015, at 14:16:23
Dr. James Greenblatt, a Boston-area psychiatrist, had a puzzling case: a teenager arrived in his office with severe obsessivecompulsive disorder (OCD), as well as attention deficit hyperactivity disorder (ADHD) and an array of digestive problems.
"Mary's parents had been running around for many years and she'd had a poor response to medicine," said Greenblatt, founder of Comprehensive Psychiatric Resources Inc. in Waltham, Mass. "When a patient doesn't respond, that's a red flag."
Greenblatt first did a simple urine test for the metabolite HPHPA, the chemical byproduct of the clostridia bacteria, and found that it was elevated. He put her on a course of high-powered probiotics to boost her good bacteria, followed by antibiotics, and her levels began to "dramatically" go down, he said.
After six months, Mary's symptoms began to disappear. And by a year, they were gone. Today, three years later, Mary is a senior in high school and has no sign of either mental disorder.
Greenblatt said he had treated hundreds of patients for dysbiosis, a condition of microbial imbalances on or inside the body. "It's a more common scenario than we know," he said.
Scientists are so far unable to identify every strain of bacteria, but they can test for the chemical byproducts that they produce, according to Greenblatt.
He said he checks every patient for HPHPA with a simple organic acid urine test before moving ahead with medications to treat symptoms.
"Eight out of 10 people are fine," he said. "But in the two patients where it's elevated, it can have profound effects on the nervous system."
"I don't know why this test isn't done on every psychiatric patient," he said. 'I question that every day."
HPHPA causes deactivation of an enzyme so that dopamine cannot be converted to the neurotransmitter neuroepinephrine, Greenblatt said, and that causes a build-up of dopamine.
"We know elevated levels in the dopamine gene cause agitation," he said, citing medical literature and case studies.
In one 2010 study at McMaster University in Canada, published in the journal Communicative and Integrative Biology, scientists found a link between intestinal microbiota and anxiety-like behavior.
The complete article:
http://abcnews.go.com/Health/anxiety-head-gut/story?id=20229136
Posted by ed_uk2010 on March 5, 2015, at 14:44:02
In reply to Re: Neurobiology of OCD - speculation, posted by Hugh on March 3, 2015, at 13:00:00
Perhaps this is a good excuse for me to increase my already high yogurt consumption!
Posted by Bill82 on March 5, 2015, at 16:18:42
In reply to Re: Neurobiology of OCD - speculation » Hugh, posted by ed_uk2010 on March 5, 2015, at 14:44:02
Very interesting, I will look into this, I do notice sometimes depending on what I eat it can effect my mood. For example to much milk and I feel lethargic/slowed.
Also an update. I had to discontinue the lamictal, as it was making me somewhat more anxious/triggered which in turn made me more iratable. Also experienced some bad word finding problems(saying tomato instead of ketchup). Pdoc decided to trial amphetamine. Took that for 3 days and only slept for around 2-3 hours a day....only took 2.5mg too..... I'm tempted to at times say I got kind of happy, but was not worth the headaches and tightening I. My chest. Also experienced worse paranoia and increased doubt of bad thoughts. Finally also had a somewhat euphoric effect that kept me coming back for more.......(father was an extreme alchohalic and I already present with bad traits, 1 beer turns into 10, almost always black out everytime I drink). Have not taken for a few days and am sleeping much better, much more calm, but still have damn ocd. Might try methylphenidate.
Other possible drugs potentially in my radar are:
Low dose or normal dose naltrexone: study here---> Endogenous Opioid Activity Is Associated with Obsessive-Compulsive Symptomology in Individuals with a Family History of Alcoholism
Keppra, what are everyone's views on this, have seen two people said it helped ocd, has calcium channel blockade of which my genetic tests showed I was messed up in that department. Of those who tried it how was your experience?
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