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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Shelley on January 20, 2002, at 13:38:08
I have been on SSRIs for OCD, depression and anxiety for years. Celexa has been especially helpful and I heard it is considered the "cleanest" AD. I now need to find a substitute for SSRIs because they all give me severe skin side effects.
Can anyone recommend something worth trying? I heard that other ADs affect other neurotransmitters such as dopamine and noradrenaline and this is something I wish to avoid.
TIA,
Shelley.
Posted by Chloe on January 20, 2002, at 20:34:33
In reply to switching ADs, posted by Shelley on January 20, 2002, at 13:38:08
Shelley,
Do you mind me asking what kind of skin probs you experience? I have awful skin probs I can't resolve, myself...I wonder if it could be connected to the Celexa???In terms of your AD question, the SSRi's are the best for OCD and rumination thoughts. I tried to switch from Zoloft to Serzone, an AD the effects primarily seratonin. It really was useless to me because it did not help with the obsessive thoughts. This to me is the problem with other non-SSRI ADs. They don't touch the obsession. Remeron (noradregenic and serotinergic) another newer AD was ineffective for the same reason as serzone. So I switched back to an SSRI, Celexa which is working ok.
So, I guess I don't have much of an answer for you...But I do know that the TCA, clomipramine is used for OCD and depression. I am not sure what neurotransmitters it targets, though...
All the best
Chloe
> I have been on SSRIs for OCD, depression and anxiety for years. Celexa has been especially helpful and I heard it is considered the "cleanest" AD. I now need to find a substitute for SSRIs because they all give me severe skin side effects.
> Can anyone recommend something worth trying? I heard that other ADs affect other neurotransmitters such as dopamine and noradrenaline and this is something I wish to avoid.
> TIA,
> Shelley.
Posted by Shelley on January 21, 2002, at 12:54:14
In reply to Re: switching ADs » Shelley, posted by Chloe on January 20, 2002, at 20:34:33
Hi Chloe,
Thank you for your response.
The skin problems I suffer from are large painful boils which require prolonged treatment with antibiotics. I also have less severe problems such as chronic dermatitis which may or not be related to the ADs, although I was on luvox when this first began.
What kind of skin problems do you suffer from? Did they begin while you were on celexa?
Regarding clomipramine, I have been on that years ago with no improvement in either the depression or the ruminations.
Perhaps it is best to look into alternatives and not become too dependent on the medication?Take care,
Shelley.
Posted by TSA West on January 21, 2002, at 13:02:11
In reply to Re: switching ADs » Chloe, posted by Shelley on January 21, 2002, at 12:54:14
There is some evidence that suggests that clomipramine alone is not as effective as both clomipramine and a noradrenergic tricyclic (nortriptyline) for OCD:
Journal of Clinical Pharmacy & Therapeutics, April 1998:
"OBJECTIVE: There is growing interest in investigating noradrenergic functions in obsessive-compulsive disorder (OCD) because some antidepressants with strong effects on serotonin reuptake blockade fail to relieve obsessive-compulsive symptoms. We undertook a trial to investigate whether the combination of clomipramine with nortriptyline was more effective than clomipramine alone. METHOD: Thirty patients who met the DSM-IV criteria for OCD completed the study. Patients were allocated in a random fashion, 15 each to clomipramine 150 mg/ day plus nortriptyline 50 mg/day and clomipramine 150 mg/day plus placebo. RESULTS: Although both protocols significantly decreased the scores of the Yale-Brown obsessive-compulsive scale over the trial period, the combination of clomipramine and nortriptyline showed a significant superiority over clomipramine alone in the treatment of OCD. CONCLUSION: As this study indicates, a rapid onset of action is one of the advantages of this combination. This study supports further investigation of the noradrenergic-serotonergic hypothesis in OCD."
Posted by Chloe on January 21, 2002, at 20:08:53
In reply to Re: switching ADs » Chloe, posted by Shelley on January 21, 2002, at 12:54:14
Shelley,
Wow, your skin troubles sound very uncomfortable. I am sorry for you difficulty with a med that is helping you. But I can see why you would want to find an alternative.
My skin problems are dryness, flaking, and "pain" or a burning sensation. Esp. on my scalp. The dermatologist thinks it's a kind of neuropathic pain on top of chronic ezcema.Low doses of amitriptyline, a TCA, and neurontin, an AED, have helped the pain some, but it's still a problem...Esp. if I want to get on a therapeutic dose of Lithium, which really works well for me. But Lithium causes such awful scalp burning...
So...I have tried many times to go med free, only to end up needing more meds to control some major crisis. So I am trying to "tolerate" the side effects from all these psych meds, so I can marginally cope.
> > Perhaps it is best to look into alternatives and not become too dependent on the medication?
Do you have any thoughts in particular on this? ARe you talking about CBT?
Too bad you got no response from clomiprimine. Perhaps some combo of clom, and another TCA like TSA West mentioned? Do you have a good pdoc to help you through all this?Take care,
Chloe
Posted by spike4848 on January 22, 2002, at 0:23:55
In reply to Combinations Tricyclics for OCD » Shelley, posted by TSA West on January 21, 2002, at 13:02:11
> There is some evidence that suggests that clomipramine alone is not as effective as both clomipramine and a noradrenergic tricyclic (nortriptyline) for OCD:
>
> Journal of Clinical Pharmacy & Therapeutics, April 1998:
>That is crap ... I have never heard a link between noradrenergic function and OCD .... I looked up that study and ...
1. These are the authors: Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Iran. Not the most reputable sources.
2. There were only 30 patients in the trial
3. The authors admit this was a weak study and recommend "This study supports further investigation of the noradrenergic-serotonergic hypothesis in OCD." Further investigation.
I would need the full article to trash it completely. Be careful of what you read and what you recommend to others.
Spike
Posted by jane d on January 22, 2002, at 1:00:35
In reply to Combinations Tricyclics for OCD » Shelley, posted by TSA West on January 21, 2002, at 13:02:11
> There is some evidence that suggests that clomipramine alone is not as effective as both clomipramine and a noradrenergic tricyclic (nortriptyline) for OCD:
..."Patients were allocated in a random fashion, 15 each to clomipramine 150 mg/ day plus nortriptyline 50 mg/day and clomipramine 150 mg/day plus placebo."
TSA,
Actually, this could as easily show that higher doses of anything do better. Do you know of any other work done in this area? And while I appreciate you posting this, it would help if you'd include all the information about these articles - especially the authors and their affiliation. I agree with Spike that it is important to consider the source.
Jane
Posted by Shelley on January 22, 2002, at 12:21:42
In reply to Combinations Tricyclics for OCD » Shelley, posted by TSA West on January 21, 2002, at 13:02:11
TSA West,
Thank you for bringing this information.
I guess there is yet a lot that needs to be understood about OCD.Shelley.
Posted by Shelley on January 22, 2002, at 12:29:42
In reply to Re: switching ADs » Shelley, posted by Chloe on January 21, 2002, at 20:08:53
Chloe,
Sorry you are also having problems with your meds.
Have you ever considered trying homeopathy or Bach remedies? I have decided to give it a try and it can't hurt. While these methods may not be substitutes for meds, perhaps they can help tolerate the side effects.Take care,
Shelley.
Posted by Chloe on January 22, 2002, at 16:24:57
In reply to Re: switching ADs » Chloe, posted by Shelley on January 22, 2002, at 12:29:42
> Have you ever considered trying homeopathy or Bach remedies?I am not sure what exactly these are and how they can be used to treat depression, etc. Can you enlighten me?
Thanks
Chloe
Posted by Shelley on January 23, 2002, at 12:05:52
In reply to Re: other remedies? » Shelley, posted by Chloe on January 22, 2002, at 16:24:57
Hi Chloe,
I found several websites which can give you some idea about the alternative remedies.
www.homeopathic.com/ailments/hespsy.htm
www.rainbowcrystal.com/bach/bach2.html
Take care,
Shelley.
Posted by Kat26 on January 23, 2002, at 20:10:24
In reply to Re: other remedies? » Chloe, posted by Shelley on January 23, 2002, at 12:05:52
I think clomipramine is the TCA that has the most influence on serotonin (among the TCAs), and that is why it is used for OCD too. Seems like serotonin drugs help OCD. However, you say it didn't work for you...
One idea that comes to mind is going on a non-SSRI antidepressant for the depression and do an intensive cognitive-behavioral therapy for the OCD?
Kat26
Posted by Shelley on January 24, 2002, at 11:01:26
In reply to Re: other remedies?, posted by Kat26 on January 23, 2002, at 20:10:24
Hi Kat,
Thanks for your input.
Do you suppose CBT also helps obsessive ruminations and a "racing mind?"Shelley.
Posted by Dinah on January 24, 2002, at 12:27:43
In reply to Re: other remedies? » Kat26, posted by Shelley on January 24, 2002, at 11:01:26
> Hi Kat,
>
> Thanks for your input.
> Do you suppose CBT also helps obsessive ruminations and a "racing mind?"
>
> Shelley.From my experience, it doesn't stop them from happening but it helps you to deal with them.
Dinah
Posted by Kat26 on January 29, 2002, at 16:21:00
In reply to Re: other remedies? » Shelley, posted by Dinah on January 24, 2002, at 12:27:43
I guess... well, I guess the cognitive part of CBT helps... learning not to fear the thoughts will actually make them become less and disappear.
Kat
Posted by Dinah on January 30, 2002, at 18:07:41
In reply to Re: other remedies?, posted by Kat26 on January 29, 2002, at 16:21:00
> I guess... well, I guess the cognitive part of CBT helps... learning not to fear the thoughts will actually make them become less and disappear.
>
> KatActually, and again only in my experience, the thoughts don't become less or disappear. It's just that you can learn to take them less seriously. Sort of "Oh, I'm doing it again." You can learn to fear the thoughts less and pay them less attention. I think the thoughts themselves are some sort of brain malfunction and only medications can help that.
Posted by Kat26 on January 30, 2002, at 21:35:59
In reply to Re: other remedies? » Kat26, posted by Dinah on January 30, 2002, at 18:07:41
Hmmm... interesting thing to think about, actually. i always thought that if you get to that stage when you can take the thoughts less seriously, after a while they will actually become less. because taking them seriously is exactly what reinforces them.
But then, I can't use myself as an example, because I am on medication too.Kat26
This is the end of the thread.
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