![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 32. This is the beginning of the thread.
Posted by matthhhh on July 18, 2003, at 18:21:17
There are several studies that indicate that morphine provides relief from ocd taken orally only once a week! Studies indicate that it acts on the caudate nucleus which the area of the brain that is implicated with ocd.Check out this info.
Exciting evidence recently published in the Canadian Journal of Psychiatry suggested morphine as an efficacious drug that showed dramatic effects in cases in which SSRI's, behavior therapy, and psychosurgery failed (Warnecke 1997). The author referenced several imaging studies showing a concentration of opioid receptors in the caudate nucleus, an aforementioned important region in the pathogenesis of OCD (Murin et al. 1980; Woo et al. 1985). Notably, none of the patients reported a euphoric response after each dose of morphine, which suggests that the mu subclass of opioid receptors may not be involved and the risk of addiction should be very low. Oral doses of morphine were given with doses ranging from 20 to 40 mg. Surprisingly, therapeutic effects lasted for at least 5 days following a single dose.
Does anyone have any experience with morphine for ocd?
I can see why this can be true, b/c I recently recieved morphine when I had my wisdom teeth taken out. For several days I had complete relief from my ocd and social phobia.
Posted by Ame Sans Vie on July 19, 2003, at 13:44:18
In reply to New Treatment to OCD and social phobia, posted by matthhhh on July 18, 2003, at 18:21:17
Well I've certainly heard case reports of opioids (morphine and tramadol in particular) helping greatly with the symptoms of OCD. And I can attest to that myself, having been on tramadol for two weeks now and finally finding myself free of obsessive thoughts and compulsive behaviors. The tramadol is also a *great* help with the social phobia and accompanying agoraphobia/dysthymia, though I don't think it would work nearly as well without my ultra-high dose of clonazepam every day.
Posted by matthhhh on July 19, 2003, at 17:35:26
In reply to Re: New Treatment to OCD and social phobia » matthhhh, posted by Ame Sans Vie on July 19, 2003, at 13:44:18
have u used any other ssri's before or just the tramadol? did u get a prescription for it or just order it online? and what is clonazepam? thanks for the reply.
Posted by Ame Sans Vie on July 19, 2003, at 23:04:37
In reply to Re: New Treatment to OCD and social phobia, posted by matthhhh on July 19, 2003, at 17:35:26
I've tried all six SSRIs... not to mention Effexor, Remeron, Wellbutrin, Serzone, Desyrel, Nardil, Elavil, Sinequan, Tofranil, and a ton of mood stabilizers, antipsychotics, stimulants, and tranquilizers. Nothing came close to working as well as Ultram, and certainly nothing can beat it (for me) as far as the side effects are concerned. And yes, I do have a prescription for it from my psychiatrist--100mg four times a day.
Clonazepam is the generic name for Klonopin, a long-acting benzodiazepine tranquilizer that's very good for anxiety in general.
Posted by matthhhh on July 20, 2003, at 14:51:29
In reply to Re: New Treatment to OCD and social phobia, posted by Ame Sans Vie on July 19, 2003, at 23:04:37
Hey Ames, thanks for the reply! Im having a problem getting Ultram, my doctor wont prescribe it to me . I think she should thought because ive been on all the ssri's and Ultram has obviously proved to be beneficial in cases of refractory ocd and social anxiety. Maybe ill have to switch doctors.
Ive been trying herbal and amino acid supplements lately ie st johns wort, 5htp, DLPA, and others, but they just dont seem to give me the boost that i need and the relief from my ocd. Do u have any experience with this "natural" route?
Ive never been on any meds like klonopin, but am very interested in trying it from what you have told me. Do u have any side effects on it? Also, did you have any extreme tiredness while on the ssri's?
I think another possible route for my ocd and social anxiety would be stimulant meds like ephedrine or dexedrine. I know this probably sounds strange since these type of meds are usually only discussed in relation to ADD, but a very small dose of ephedrine 5mg, it totally relieves my ocd and social anxiety. Havnt tried dexedrine but i think it could be similar.
Thanks for your help!
Posted by Ame Sans Vie on July 20, 2003, at 18:52:27
In reply to Re: New Treatment to OCD and social phobia, posted by matthhhh on July 20, 2003, at 14:51:29
> Hey Ames, thanks for the reply! Im having a problem getting Ultram, my doctor wont prescribe it to me . I think she should thought because ive been on all the ssri's and Ultram has obviously proved to be beneficial in cases of refractory ocd and social anxiety. Maybe ill have to switch doctors.
Yeah, my previous two doctors didn't want to give me Ultram either... one was just totally like "no way", the other was more open to the idea but I don't think he would have actually gone for it until I'd tried at least another 3,200 combinations of meds that have never worked for me, lol. I think it may be a good idea to look for a new doctor... if they're willing to prescribe you an opioid (or even a quasi-narcotic, like Ultram) out of *compassion*, then that definitely makes them a winner in my book.
> Ive been trying herbal and amino acid supplements lately ie st johns wort, 5htp, DLPA, and others, but they just dont seem to give me the boost that i need and the relief from my ocd. Do u have any experience with this "natural" route?
I've spent a few years using the "natural" therapies as adjuncts to my medications, and there are certain supplements I won't do without. St. John's Wort and 5-HTP did absolutely nothing for me. I haven't tried DLPA, but I'm considering adding it on to my current regime considering that it *may* help prevent tolerance from developing to the Ultram (though personally, I feel tolerance is not an issue with this med when it's used psychiatrically, as its action seems predominantly to be related to its 5HT and NE reuptake inhibition qualities... I say this because its affinity for mu-opioid receptors has been described as being 1/6000th as potent as morphine's, though Ultram's main active metabolite is slightly more active at those receptors).Anyway, as for my history with other supplements... well, this may take a while, lol.
L-Theanine: Liked it. Created sort of a calm, collected feeling... sort of like the "centeredness" that picamilon provides. Too expensive for the good quality stuff though.
L-Glutamine: Tried it because I'd read it was a precursor to glutamate, which is a precursor to GABA. It also is purported to reduce levels of lactic acid, which can be a cause of anxiety. I don't think it had any effect on my anxiety either way, but it definitely helped control my carb cravings!
Pregnenolone: Read one study that suggested levels of pregnenolone tended to be lower in patients with social anxiety, so I tried 30mg each day for several months, to no avail.
Acetyl L-Carnitine: I was mainly taking this as an adjunct to my low-carb diet at the time, as Dr. Atkins recommends it in his book "Dr. Atkins' New Diet Revolution". It did help me lose weight more quickly on the diet, but as for the mild mood-elevating properties it's said to possess... well... they must be *really* mild, lol.
L-Taurine: This particular amino acid is said to help regulate neurotransmission in some way or another, but I personally didn't find it helpful.
And here are the ones that I've tried and am still taking:
Picamilon: This is GABA (the neurotransmitter some describe as your brain's 'natural Valium') bonded to niacin at the molecular level. GABA supplements alone are basically useless as far as mental health is concerned--the GABA in those capsules is incapable of crossing the blood-brain barrier. But bonded to niacin, which *is* capable of crossing the BBB, it is able to get to where it needs to go. It provides quick relief of anxiety and depression, while at the same time providing a nice energy boost. I'd describe it's effect as a total mind "centering". I take 100mg three times daily, without food.
L-Tyrosine: I love this stuff!! I also supplement with P-5-P (a form of vitamin B6) which is essential when taking L-Tyrosine, and L-Phenylalinine, which I personally feel is essential while taking L-Tyrosine. I take one 500mg capsule each morning upon waking *up on an empty stomach*--very important to the amino acid's absorption.
L-Phenylalinine: This, combined with L-Tyrosine and P-5-P, does quite a bit to improve my energy, stamina, and concentration abilities. All three of these work together to improve function of the dopaminergic and nor/adrenergic systems. L-Phenylaline in particular metabolizes into L-Tyrosine, though it seems to have immediate stimulant effects that L-Tyrosine alone lacks. I take two 500mg capsules each morning, with food.
P-5-P (Pyridoxal-5-Phosphate): As I mentioned above, this is a form of vitamin B6 (pyridoxine) which is more readily available for use by your body. It's absolutely essential to be taking this while supplementing with L-Tyrosine--it plays an integral role in converting L-Tyrosine into dopamine, norepinephrine, and epinephrine. I take 25mg each morning, with food.
Niacinamide: This is a form of vitamin B3 (niacin) that has been shown to bind to benzodiazepine receptors in the brain. I find it to have a very nice calming effect, not unlike a low dose of a relatively non-sedating benzo like Serax. Very good for background stability. I take two 1,500mg extended-release tablets each morning, with food.
Lecithin: Lecithin contains phosphatidyl choline, which is a precursor to acetylcholine, a brain neurotransmitter largely involved in memory and mental function. I haven't been taking it long, but I've heard a lot of good about it and am beginning to notice subtle improvements already in memory recall and short-term memory. Definitely a good supplement to take if you're on chronic benzodiazepine therapy (like me) since benzos can cause minor problems with memory. I take one tablespoon of it everyday with food, which contains 4.8 grams.
Selenium: Good for prostate health, and even though I'm only a 20-year-old male, I firmly believe that an ounce of prevention is worth a pound of cure. I take 100mcg each morning, with food.
Vitamin C with Rose Hips: Pretty self-explanatory... I take two 500mg tablets each morning, with food.
Vitamin B Sublingual Liquid Complex: A vitamin B complex is essential to good health, in my opinion, and especially good mental health. But don't waste your money on the tablets--most of the contents of those doesn't even get absorbed into your system. This liquid form is placed under the tongue, where it is held for about 30 seconds to allow most of the vitamins to absorb through the lining of the mouth, then you just swallow it. Doesn't taste bad either... the kind I have has a berry flavor to it. I take 1 dropper-full each morning, with food.
Vitamin E: Another one that's pretty self-explanatory. Since they're oil-based pills though, they should always be taken separately from powder-based pills to ensure proper absorption. I take three 400mg capsules daily, with food.
Fish Oil: Don't ask, just take them, lol! They're so wonderful for your health in so many ways, there's no excuse not to. They're oil-based, so I take them with my vitamin E. I take 3 capsules daily, each containing 180mg EPA and 120mg DHA.
"Green Source" brand supplement: This is the ultimate multivitamin, multimineral, multi-everything supplement. The one I take is made by Vitamin World, though I'm sure there are equivalents made by other companies. This is what rounds off my entire supplement program. I've tried all sorts of other multivitamin/mineral supplements, but I've never found one that made me feel as good as this one does. I take one tablet three times daily, with food. Each three tablets contains:
Vitamin A (100% as beta carotene) -- 15,000 I.U.
Vitamin C -- 1,000mg
Vitamin D -- 400 I.U.
Vitamin E -- 250 I.U.
Thiamin (vitamin B1) -- 25mg
Riboflavin (vitamin B2) -- 25mg
Niacin (vitamin B3) -- 25mg
Vitamin B6 -- 25mg
Folic Acid -- 400mcg
Vitamin B12 -- 25mcg
Biotin -- 50mcg
Pantothenic Acid -- 25mg
Calcium -- 250mg
Iron -- 15mg
Iodine -- 150mcg
Magnesium -- 125mg
Zinc -- 15mg
Selenium -- 25mcg
Copper -- 500mcg
Manganese -- 4mg
Chromium -- 100mcg
Molybdenum -- 50mcg
Potassium -- 50mg
Boron -- 1mg
Choline Bitartrate -- 50mg
Inositol -- 25mg
PABA (Para-Aminhobenzoic Acid) -- 25mg
Citrus Bioflavonoids Complex (Orange) -- 100mg
Quercetin -- 25mg
Rutin -- 25mg
Hesperidin (Orange) -- 10mg
Bromelain (Pineapple-2,000GDU/gm) -- 20mg
Betaine HCl -- 20mg
Papain (Papaya) -- 20mg
Amylase -- 5mg
Lipase -- 5mg
Protease -- 1mg
Cellulase -- 2.5mg
Proprietary Lactobacillus Blend -- 25mg
Oat Bran (Avena sativa [husk]) -- 25mg
Pectin (Apple) -- 25mg
RNA -- 35mg
DNA -- 10mg
Carotenoids -- 10mg
Vegetable Oil (Borage and Sunflower) -- 100mg
L-Glutathione -- 5mg
Spirulina -- 1,000mg
Wheat Grass Juice (dry) -- 100mg
Sprouted Barley Juice (dry) -- 100mg
Flaxseed Oil (dry) -- 100mg
Chinese Chlorella (broken cell wall) -- 100mg
Bee Pollen -- 100mg
Siberian Ginseng (Eleutherococcus senticosus) -- 50mg
Dehydrated Garlic (Allium sativum) -- 10mg
Echinacea -- 10mg
Milk Thistle -- 10mg
Goldenseal -- 10mg
Ginger Root -- 10mg
Gingko Biloba -- 10mg
Cayenne Pepper -- 10mgFinally, there are some herbs that I take in different forms (most of the preparations I make myself) on an as-needed basis:
Kava Kava: I've once heard this described as "the forgotten narcotic". And that's definitely not an overstatement. If you buy good quality kava kava (I find the kava from this site, http://www.mauigateway.com/~kava/kava.html, to be far superior to all others I've tried) it can be a wonderful way to wind down at the end of the day, or even a substitute for alcohol at parties! Every friend who's had the opportunity to try one of my kava chai drinks has been shocked at the potency and says they'll swear off alcohol for good if they can just come by my house once every week or two for one of my kava parties, lol. This is not something to take every day though, as it can cause liver problems. Its effects include elimination of anxiety and increased sociability, without any slowing of thought processes that traditional tranquilizers can cause. Here's my own personal recipe for cold kava chai, which serves two (and it's always a good idea to take some lecithin about an hour before using kava--it greatly enhances the effects):
INGREDIENTS
1/2oz. ground kava root
1 cup half-and-half
1 bag Darjeeling tea, decaf
6 cardamom pods
1 tsp anise seed
10 cloves
1 cinnamon stick
1/8" ginger root, sliced thin
1/8 tsp black pepper corns
1 bay leaf
Honey
Powdered nutmeg or allspicePREPARING THE KAVA HALF-AND-HALF
1. Place ground kava root in half-and-half and leave in the refrigerator overnight. (kavalactones, the active constituents of kava kava, are highly fat-soluble)
2. After at least 12 hours of maceration in the refrigerator, strain the kava root from the half-and-half. Coffee filters work well for this.PREPARING THE TEA
1. Boil 1 cup water, then steep the remaining ingredients for 10-15 minutes, and strain.
2. Sweeten with honey, but make it a little sweeter than you want it. This is because you'll be adding the half-and-half next, but you'll want to wait to do that until the tea is cool--excessive heat destroys kavalactones, and honey doesn't integrate well with cold beverages.FINAL PREPARATION
1. Use two large mugs, and in each pour a half cup of the tea (which has been allowed to cool) and a half cup of the kava half-and-half. Sprinkle with nutmeg or allspice, and serve.Scullcap: This is a great herb, which many consider to be a suitable substitute for marijuana. It can be smoked, but for better effects, you should make an infusion. An infusion is essentially a tea, but with one crucial difference--you want to make sure that the water has cooled to about 170-180° before steeping the herb in it. Boiling water destroys the active constituents in many herbs. Its effects are similar to marijuana in many regards, but much milder. Just a great "relax-after-a-hard-day" kind of herb. This information also applies to catnip, damiana, and vervain, more or less.
Rosemary: Rosemary tea is a rather ancient remedy for depression, and it does work rather well if drunk regularly. Just don't drink more than one cup of tea per day, as high levels can be toxic. If I'm having a lot of stress in my life and am feeling down about something, I'll start drinking rosemary tea and within a couple days I'll begin to feel relief.
There are many other herbs I use for different purposes, including some much less well-known ones (blue lotus, betel nut, and sceletium tortuosum, for example), but these are the mainstays of my "herbal diet". I always keep homemade tinctures of my favorite herbs on hand. This is easily done by steeping the herb in 100-proof vodka for 2-4 weeks in a warm, dark place, taking it out once a day to shake it. After a few weeks, you simply strain out the plant material and use the tincture by adding around 20-30 drops to a drink, or just taking it sublingually, like the liquid B-vitamin complex.
I'm very interested in trying homeopathic remedies, as I've read quite a bit about them lately. The Bach flower remedies sound interesting too... in fact I think I'll post about them once I'm through writing this to see if anyone has any experience/advice.
> Ive never been on any meds like klonopin, but am very interested in trying it from what you have told me. Do u have any side effects on it? Also, did you have any extreme tiredness while on the ssri's?
I personally have never experienced side effects from Klonopin, though most people feel sleepy the first week or two of regular use. I just have a really whacked out brain chemistry, I suppose. I have yet to find a medication that even makes me drowsy. Ambien, Elavil, Remeron, trazodone, Restoril, Tuinal--none of them make me sleepy in the least. So far the only thing that seems to be able to do it for me is massive doses of barbiturates or narcotics. Go figure.
As for the SSRIs, yes, I did feel quite a bit of fatigue on them... Paxil and Luvox in particular. I'm not a big fan of the SSRIs. I personally feel that the idiots who market them should be forced to take them themselves, to see how *they* like it.
> I think another possible route for my ocd and social anxiety would be stimulant meds like ephedrine or dexedrine. I know this probably sounds strange since these type of meds are usually only discussed in relation to ADD, but a very small dose of ephedrine 5mg, it totally relieves my ocd and social anxiety. Havnt tried dexedrine but i think it could be similar.
Stimulants have been known to be helpful for a lot more than ADHD and narcolepsy. Quite a few people cite Dexedrine, Adderall, and Desoxyn as increasing sociability, especially when combined with a benzodiazepine (Klonopin in particular). I've never heard of them helping OCD, but that certainly doesn't mean it's not possible. I definitely wouldn't recommend taking ephedrine though--its peripheral effects are awful and regular use of it can cause damage to the cardiovascular system... quite possibly the central nervous system as well. I'd suggest you bring this up with your doctor though. Maybe a trial of Dexedrine would do the trick.
> Thanks for your help!No problem, sorry this was so long--I'm just feeling really good today and felt like contributing, lol. Any other questions you have, feel free to ask!
~~Michael
Posted by Ame Sans Vie on July 21, 2003, at 17:44:37
In reply to Re: New Treatment to OCD and social phobia, posted by Ame Sans Vie on July 20, 2003, at 18:52:27
Be sure to make note of my use of the double-double quotes feature in the previous post. Do I get my brownie points, lol? ;-)
Posted by Dr. Bob on July 21, 2003, at 18:51:03
In reply to Dr. Bob, posted by Ame Sans Vie on July 21, 2003, at 17:44:37
Posted by matthhhh on July 21, 2003, at 18:54:23
In reply to Dr. Bob, posted by Ame Sans Vie on July 21, 2003, at 17:44:37
Hey there Ame, so i went to a new doctor today and when i got there i saw a sign on the front desk saying "we do not prescribe narcotics for walk ins" So needless to say i was unsuccessful in getting a prescription for morphine or ultram, and not even for klonopin.
Some doctors are SOO IGNORANT, all they seem to go by sometimes is their med school books and what the ssri companies tell them about their superior products. They are the experts and their way is always right. Well the only experts on meds are the people who take them. Their the ones who know what really works for them and what doesnt. Sorry to be so negative but this is kind of frustrating.
Anyways he said that klonopin was very addictive and was only a "bandaid"- i was like and what are ssri's supposed to be?
So he gave me a prescription for remeron, the only ssri that i havnt tried. I dont know if i should take it or not. Maybe it'll be the one that doest cause tiredness but I highly doubt it.
Posted by Ame Sans Vie on July 21, 2003, at 19:17:27
In reply to Re: Dr. Bob, posted by matthhhh on July 21, 2003, at 18:54:23
I totally hear you about all psychiatric drugs being "bandaids" in a sense. It is totally ignorant of them to single out Klonopin, especially in this day and age when Klonopin is rapidly gaining popularity among psychiatrists as the preferred benzodiazepine, especially for long-term use.
As for Remeron, it is not an SSRI, but actually the first of a new class of antidepressants called NaSSA's (noradrenergic and specific serotonergic antidepressants). It enhances noradrenergic transmission by blocking alpha2-autoreceptors, in addition to enhancing serotonergic transmission by alpha1-adrenoceptor stimulation, and blockade of 5-HT2 and 5-HT3 receptors, which results in enhanced 5-HT1 mediated neurotransmission. (according to http://www.remeron.com) You were mentioning that you you were hoping it doesn't cause drowsiness, but you might be disappointed to hear that Remeron has an antihistamine action and is often prescribed for sleep--it causes extreme sedation. Not to mention that it rarely works for the majority of patients who take it.
If you can't find a compassionate psychiatrist, I'd recommend looking for a psychopharmacologist. They are generally more willing to give to you whatever it is you feel you need, and are often much more open to suggestion than psychiatrists (or so I hear).
Posted by matthhhh on July 21, 2003, at 19:38:46
In reply to Re: Dr. Bob, posted by Ame Sans Vie on July 21, 2003, at 19:17:27
I think im going to order ultram online. So what is your dose Ame?
Posted by Ame Sans Vie on July 21, 2003, at 19:42:06
In reply to Re: Dr. Bob, posted by matthhhh on July 21, 2003, at 19:38:46
I started at 50mg three times daily, and am now on what is generally considered to be the most therapeutic dose, 100mg three times daily. You should start slow with Ultram, as it has a tendency to cause nausea the first few times you take it. Taking it with food helps quite a bit though, and doesn't interfere with its absorption.
Posted by matthhhh on July 22, 2003, at 13:47:12
In reply to Re: Ultram dose, posted by Ame Sans Vie on July 21, 2003, at 19:42:06
Hey Ame, wow that must be very expensive. Do u thinks its worth it? By the way what do u pay for yours?
Posted by matthhhh on July 22, 2003, at 16:23:37
In reply to Re: Ultram dose, posted by matthhhh on July 22, 2003, at 13:47:12
Have you ever considered taking morphine instead of Ultram. Theres been a number of research studies that indicate that one dose of morphine 20-40 mg, relieves ocd symptoms and social anxiety for a period of at least 5 days. And it also suggests that risk of addiction is very low. I found this information on morphine.
Exciting evidence recently published in the Canadian Journal of Psychiatry suggested morphine as an efficacious drug that showed dramatic effects in cases in which SSRI's, behavior therapy, and psychosurgery failed (Warnecke 1997). The author referenced several imaging studies showing a concentration of opioid receptors in the caudate nucleus, an aforementioned important region in the pathogenesis of OCD (Murin et al. 1980; Woo et al. 1985). Notably, none of the patients reported a euphoric response after each dose of morphine, which suggests that the mu subclass of opioid receptors may not be involved and the risk of addiction should be very low. Oral doses of morphine were given with doses ranging from 20 to 40 mg. Surprisingly, therapeutic effects lasted for at least 5 days following a single dose.
Another type of treatment is based on a theoretical conception of aberrant reward systems in OCD. It has been hypothesized that there is a failure of the endogenous reward system to signal satisfactory completion of an act. This reward system is under partial control of the endogenous opioids. Naloxone, a competitive opiate antagonist, exacerbates OCD symptoms. Franz and colleagues[12] randomized 8 treatment-refractory OCD patients to oral morphine (ie, MS Contin), lorazepam, or placebo. All patients received a 2-week trial of each agent in random order, in a double-crossover, double-blind design. A single dose of oral morphine resulted in a greater improvement in OCD symptoms than lorazepam or placebo, as reflected by a decrease of more than 40% in YBOCS scores. Case reports also suggest that tramadol, an opioid receptor mixed agonist/antagonist with some serotonin and norepinephrine reuptake properties, is efficacious in reducing OCD symptoms.[13,14] Double-blind studies of tramadol's efficacy in treatment-resistant OCD are currently underway.
A Possible New Treatment Approach to ObsessiveCompulsive Disorder Dear Sir: I would like to report on a possible new treatment approach to obsessivecompulsive disorder (OCD). The use of narcotic antagonists and agonists has been of great benefit in a small number of treatment-resistant cases of OCD and OCD-spec- trum disorders that have presented to the anxiety disorders clinic where I work. Two cases will be briefly discussed and the rationale for the use of narcotic agonists/antagonists also briefly reviewed.
Case 1 is a 55-year-old, divorced, unemployed female who had severe OCD since early adolescence. Her main symptoms consisted of cleaning, checking, and preoccupation with de- tail that resulted in extreme slowness. Her illness waxed and waned but had become progressively worse over the years. Response to the usual antiobsessional medication was minimal. Under the care of a previous psychiatrist, she had received bilateral cingulotomies with no benefit. Under my care for the last 6 years, the patient showed no response to trials of all of the selective serotonin reuptake inhibitors (SSRIs), alone or in combination, or to a course of intravenous clomi- pramine infusions. Electroconvulsive therapy relieved her comorbid depression only for a short period of time. Cognitive behavioural therapy provided by an experienced behavioural therapist was of limited benefit. A further psychosurgical procedure of bilateral anterior capsulotomy provided only temporary modification of symptoms. Over the last 2 years she developed a new symptom of compulsive picking that has become so severe that on admission to hospital, her face, breasts, and abdomen were severely excoriated. Demoralized, with few remaining family supports, she was being assessed for a nursing home placement because she no longer was able to cope on her own. On the basis of reports in the veterinary literature of narcotic antagonists being effective in compulsive behaviours in animals, as well as on the proven safety of naltrexone in the treatment of drug and alcohol addiction, I decided to try this approach in this patient. Naltrexone 50 mg/day was given initially and then increased to 100 mg/day. Within a few days, the compulsive picking dramatically decreased, although the patient continued to be very dysphoric. At this point, based on an anecdotal report from another patient with severe OCD that her symptoms had dramatically remissed for up to a week when given morphine following surgery, I elected to try a narcotic agonist in this particular case. After a suitable washout period for the naltrexone, morphine sulphate was given subcutaneously in a dose of 10 mg. The response was dramatic. Twenty-four hours later, the patient remained mildly euphoric and free of all OCD symptoms. This state lasted for several days. Oral morphine was then tried, and after some adjustment, a dose of 30 mg was found to be effective for 6 to 7 days, particularly diminishing the compulsive picking and the dysphoria. Other narcotic agonists, such as propoxphene and pentazocine, had no effect. The patient continued to do well on the oral morphine and entered a rehabilitation program, where the morphine was discontinued. She suffered a relapse, but now she remains much improved after the morphine was restarted at a dose of 30 mg every 5 to 6 days.
Case 2 was a 35-year-old single female who was unem- ployed but trained as an accountant. She had severe trichotillomania, which began in her early 20s; she had received extensive treatment for this condition, but all of the SSRIs, including clomipramine, had been ineffective. She had no other symptoms of OCD or depression. The trichotillomania worsened under stress and was confined to her head and eyebrows. She wore a wig because of large areas of baldness. Her life had become very restricted because of the time spent in hair-pulling activity and the embarrassment of her being bald. Repeated trials of SSRIs with augmentation remained ineffective. A trial of naltrexone was undertaken at 100 mg/day. After 2 to 3 weeks, the trichotillomania dramatically decreased, and her hair started growing back. Unfortunately, she could not afford the cost of the medication and discontinued it with a return of symptoms.
Since these 2 cases were treated, 4 other end-stage cases of OCD (the only other option was psychosurgery) have been successfully treated with oral morphine, the dose ranging from 20 to 40 mg given every 5 to 8 days. Three cases of OCD-spectrum disorder (2 with trichotillomania, one with compulsive gambling) have been treated with naltrexone with marked improvement. Morphine works primarily on the mu receptor with analgesia and/or euphoria being the result, but it has an effect on the other receptors as well. Subtypes of each receptor have also been identified, and of possible relevance to OCD is the concentration of opioid receptors found in the striatal system, particularly the caudate nuclei (16,17), which appear to be an important region in the pathogenesis of OCD (18,19). In the cases in which morphine was useful, it is puzzling why the effect lasted for at least 5 days following a single oral dose. None of the patients reported a euphoric response beyond what could be expected as a result of symptom relief. This suggests the involvement of opioid receptors other than the mu receptor. The risk of addiction, if this is true, should be very low, if it exists at all. The cases discussed are being followed very closely from this perspective, but there has been no evidence of dose escalation. The response to narcotic agonists or antagonists in a few cases is similar to that reported in the veterinary literature and reinforces the concept of a neuroethological approach to the understanding of OCD, with a possible common pathogenesis for stereotypies in animals, such as the acral lick syndrome in dogs, and similar repetitive motor behaviours in humans, such as compulsive picking or hair pulling (20,21). Although there are many useful treatment approaches for OCD, about 30% of patients do not respond to traditional therapy and continue to remain very chronically ill. The last-resort treatment is often psychosurgery, a procedure not readily available for most (22). It is hoped that this letter may stimulate other thoughts on this subject. Clearly, there is a need for research. Of interest, a recent television documentary on medical advances had a short section on OCD. A psychiatrist from Baylor Medical College in Texas was interviewed and made a brief comment about the successful use of morphine in a few cases of otherwise intractable OCD. I am in the process of trying to find the name of this individual..
Posted by Ame Sans Vie on July 22, 2003, at 19:56:08
In reply to Re: Ultram dose, posted by matthhhh on July 22, 2003, at 16:23:37
I definitely feel that it's worth it, but then again I don't pay for it, as I'm on Medicaid, lol.
Morphine provided no relief of my OCD symptoms at all, and I've tried it as recently as just a few weeks ago when I was prescribed paregoric for irritable bowel syndrome. I think Ultram's method of action makes a lot more sense.
Posted by matthhhh on July 23, 2003, at 12:14:34
In reply to Re: Ultram dose, posted by Ame Sans Vie on July 22, 2003, at 19:56:08
Hey Ame, thanks for the reply. That's interestintg that Morphine did not provide any relief for you. I wonder if dentists give morphine or ultram. I got my wisdom teeth taken out lately and whatever they gave me helped me out a lot.
Anyways have you ever experimented with marijuana for your symptoms? I find it takes away my social anxiety/ocd. I noticed that you posted something about a new drug for anxiety that is currently under research that is similar to the actions of marijuana. Isn't there anything out there now that provides similar relief?
Posted by paxvox on July 23, 2003, at 16:46:01
In reply to Re: Ultram dose, posted by Ame Sans Vie on July 22, 2003, at 19:56:08
Ultram mimics opioids, and is techically considered an opioid pharmacologically. It seems that this "info" has only become apparent in the literature over the past few years. Only recently have I read about its use as an antidepressant. Interestingly, it is NOT considered or treated as a contolled substance in the U.S. even though it is described by its manufacturer as having "a potential to cause psychic and physical dependence of the morphine-type." Tramadol and its metabolites, bind to the same M-1 opioid receptors in the brain as other opiods and opiates. Its antidepressant qualities probably come from the fact that it "has shown to inhibit reuptake of norepinephrine and serotonin...as have some of the other opioid analgesics." This information is from the manufacturer of Ultram, Ortho-MCNeil, as printed in the PDR. I have long been a proponent of opioid/opiate use as legitimate antidepressants when used and prescribed RESPONSIBLY. Of course, the great fear of addiction make their use far too controversial for mainstream docs to want to mess with. Ultimately, I believe we will discover quite a bit more about brain chemistry in the coming years that may help chase away this stigma. As with most change, however, it requires time for a paradigm shift to take effect.
PAX
Posted by Ame Sans Vie on July 23, 2003, at 17:03:52
In reply to Re: Ultram dose, posted by matthhhh on July 23, 2003, at 12:14:34
I just had my Ultram dose raised to 400mg/day today (see my post below, "Change of Meds Today") and also went off the Klonopin 6mg in favor of a trial of Xanax XR 3mg. Will let you know how that turns out.
Most dentists tend to use either Ultram, Darvon, Darvocet, Vicodin (regular, ES, or HP), codeine phosphate, or Tylenol with codeine for post dental extraction pain, as far as my experience has shown me.
Actually, I've always found marijuana to be the greatest thing for relieving *all* of my symptoms, of every disorder I've been diagnosed with. It's absolutely wonderful for me. Dronabinol (see my reply to your post below) helped too, but only about 50% as well as marijuana. By the way, I don't normally smoke it--I either vaporize it or use cannabis-butter in my cooking. Both of these methods completely spare your lungs the negative effects of smoking it.
Posted by Caleb462 on July 24, 2003, at 0:13:28
In reply to Re: Ultram dose, posted by Ame Sans Vie on July 23, 2003, at 17:03:52
Opiods are by far the most effective drug I have ever used for treating the obsessive side of OCD... but I have always found that the effect wears off when the drug wears off. No long term benefit. Opiods make me feel absolutely wonderful, no depression, much less OCD, much less anxiety, etc. The opiod high is a high without an equal. But alas, they only make things worse for me in the end.
Anyway... as for Ultram, some of its AD effects may come from serotonin/norepinephrine reuptake inhibition, but I'd say the majority come from stiumulation of mu-opiod receptors. People are fooling themselves if they don't believe this to be true. Ultram is very much a narcotic, due mostly to its signifigantly active metabolite.
Posted by River1924 on July 24, 2003, at 0:32:11
In reply to Re: Ultram dose, posted by Ame Sans Vie on July 23, 2003, at 17:03:52
Posted by Ame Sans Vie on July 24, 2003, at 0:47:27
In reply to cannabis butter??? (nm) » Ame Sans Vie, posted by River1924 on July 24, 2003, at 0:32:11
Sure--THC is fat-soluble, so cooking marijuana in butter and then removing the plant matter leaves you with a butter that contains THC. I find it tastes no different from regular butter, and can be substituted for it in any circumstance... though my favorite way to eat it is melted over popcorn. :-)
Posted by stjames on July 24, 2003, at 13:14:10
In reply to Re: Ultram dose, posted by Ame Sans Vie on July 23, 2003, at 17:03:52
> Actually, I've always found marijuana to be the greatest thing for relieving *all* of my symptoms, of every disorder I've been diagnosed with. It's absolutely wonderful for me. Dronabinol (see my reply to your post below) helped too, but only about 50% as well as marijuana. By the way, I don't normally smoke it--I either vaporize it or use cannabis-butter in my cooking. Both of these methods completely spare your lungs the negative effects of smoking it.
Delta9-TCA is just one of many canabinoids in pot.
Delta9-TCA is the one studied, but it has long been suggested it is the synergy of several actives that accounts for pots many effects.
My friends with AIDS also report that Marinol
does not have the same effect as pot. It is too
strong and does not have the anti-nausea effects.Many scoff at pot, yet the body has THC receptor sites, much like the neurotransmitters do. So it follows that we were intended to ingest pot or that THC actives are important to function.
Posted by Viridis on July 24, 2003, at 14:26:12
In reply to Re: Ultram dose, posted by stjames on July 24, 2003, at 13:14:10
I have nothing in particular against pot, but the fact that humans have THC receptors doesn't necessarily mean that people were "intended" to use it. There are all sorts of receptors that were first characterized by response to a particular chemical -- for example, the "nicotinic" receptors bind nicotine (this is how they were first discovered), but I doubt this means that we were intended to smoke tobacco. And in the body, they're not binding to nicotine (unless you introduce it); they respond to other chemicals that have some similarity to nicotine.
In many cases, there's a natural (or synthetic) chemical that's similar enough in some ways to a substance produced in the body that it can bind to the receptors for the body's chemical and activate the cells that have those receptors. Sometimes this is a positive thing, and I don't disagree that THC and other components of marijuana can be beneficial for some people. But again, this doesn't mean that we were "intended" to use it. An awful lot of poisons (especially neurotoxins) interact with receptors in some way, yet obviously this isn't the result of a "need" for these substances.
Posted by matthhhh on July 24, 2003, at 18:39:33
In reply to Re: Ultram dose » stjames, posted by Viridis on July 24, 2003, at 14:26:12
Some of you are saying that marijuana takes away all anxiety/ ocd symptoms, and I agree, but I feel really paranoid sometimes when im in social situations with lots of people.
In this respect, would you consider ultram better than marijuana?
Posted by stjames on July 24, 2003, at 18:42:54
In reply to Re: Ultram dose » stjames, posted by Viridis on July 24, 2003, at 14:26:12
> I have nothing in particular against pot, but the fact that humans have THC receptors doesn't necessarily mean that people were "intended" to use it.
Yea, I winced when I saw I posted that !
Should of read:
So it follows THC like actives are important to function.The point I was trying to make was that we need to be careful when we make across the board statements like "XTC will fry you or LSD is bad for you" because substances much like them are endogenous. Many neurotransmitters are very very slightly different from psychedelics. Many NT's are indole based, as are many psychedelics. DMT is endogenous AND a psychedelic.
LSD and 5HT are only slightly different.Nature is telling us something, I don't know what. But I don't thing we should be banning these substances and conducting scare studies on them.
Given that people have been taking them for
centuries without major problems in a large number of people I find that my tax $$ going to produce studies where huge doses are given to rats
just to prove something is absurd.
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