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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by krybrahaha on February 9, 2004, at 2:02:17
I am on 300 mgs of Luvox for OCD and it isnt doing a whole lot for it. My p-doc added Buspar 10 mg twice daily and said that might help, but it seems to be making it worse. What are some other good meds to augment with an SSRI for OCD/Anxiety? Ive heard that low doses of anti-psychotics can be helpful, is this true. Whats you opinion.
Posted by Chairman_MAO on February 9, 2004, at 8:13:27
In reply to BEST MED TO AUGMENT WITH AN SSRI FOR OCD?, posted by krybrahaha on February 9, 2004, at 2:02:17
The first-line med to augment an SSRI for OCD is clonazepam, 1-6mg/day. Low-dose atypical antipsychotics can be used; I believe the one with the most evidence backing it is Zyprexa. Try 2.5-10mg/day for that one. Amisulpride, risperidone, quetiapine, and others might work too.
This may sound crazy, but I'd be willing to bet that AMPHETAMINE could work wonders--and there are studies to back me up. _NOT_ ritalin, but adderall/dexedrine/desoxyn. So can opioids, even given only a few times per week. But good luck getting this treatment unless you've failed all else AND have a compassionate doctor who prefers to meet with you over a drink while asking you for his opinion on his book, "101 Ways to Say "Bugger Off" to a DEA Agent"
Posted by Sad Panda on February 9, 2004, at 10:22:04
In reply to BEST MED TO AUGMENT WITH AN SSRI FOR OCD?, posted by krybrahaha on February 9, 2004, at 2:02:17
> I am on 300 mgs of Luvox for OCD and it isnt doing a whole lot for it. My p-doc added Buspar 10 mg twice daily and said that might help, but it seems to be making it worse. What are some other good meds to augment with an SSRI for OCD/Anxiety? Ive heard that low doses of anti-psychotics can be helpful, is this true. Whats you opinion.
>If Luvox ain't cutting it maybe you should consider getting rid of it & try another SSRI like Zoloft or go for the OCD gold standard Clomipramine.
Cheers,
Panda.
Posted by BobS. on February 9, 2004, at 17:50:29
In reply to Re: BEST MED TO AUGMENT WITH AN SSRI FOR OCD?, posted by Chairman_MAO on February 9, 2004, at 8:13:27
Chairman,
My p-doc is about to try amphetamines with me for mild ocd. If you have and links to studies, I would appreciate it. I did Medline, etc, but I suspect there may be other sources.
Regards,
BobS.
Posted by Chairman_MAO on February 9, 2004, at 20:06:29
In reply to Chairman-do you have links to amphet for ocd, posted by BobS. on February 9, 2004, at 17:50:29
If I were enrolled in school now I'd try to get you the text. Basically, this is my theory:
If you have a properly dosed buzz (e.g., not too much, not too little, and 30mg is a proper dose of d-amphetamine), you are less likely to be obsessive. ;)
Ritalin's a crappy buzz.
Woolley JB, Heyman I.
Related Articles,LinksDexamphetamine for obsessive-compulsive disorder.
Am J Psychiatry. 2003 Jan;160(1):183.---
J Clin Psychopharmacol. 1991 Aug;11(4):237-41.
Acute psychostimulant challenge in primary obsessive-compulsive disorder.
Joffe RT, Swinson RP, Levitt AJ.
Department of Psychiatry, Toronto General Hospital, Ontario, Canada.
The effects of acute oral administration of methylphenidate 40 mg versus dextroamphetamine 30 mg versus matched placebo were compared in 11 patients with primary obsessive-compulsive disorder. Dextroamphetamine but not methylphenidate had a significantly greater antiobsessive-compulsive effect as measured by the Comprehensive Psychiatric Rating Scale--Obsessive-Compulsive Subscale, as compared with placebo. This effect appeared unrelated to their effect on depression although a differential effect of the two psychostimulants on anxiety was observed. Although both these stimulants affect serotonin, the differences noted between dextroamphetamine and methylphenidate suggest that catecholamines may be implicated in the pathophysiology of obsessive-compulsive disorder.
Posted by Interject79 on February 10, 2004, at 23:07:31
In reply to Re: Chairman-do you have links to amphet for ocd » BobS., posted by Chairman_MAO on February 9, 2004, at 20:06:29
Chairman makes an excellent point. Stimulants have done wonders for my obsessive-compulsive traits. It helps me break obsessions and improves mood. Dextroamphetamine makes the most sense too; other stimulants aren't as 'clean'. My experience has been bad with SSRIs for OCD, though mine is admittedly not a typical case in any other respect. Augmenting didn't help, with the exception of augmenting with a low dose of Zyprexa in cases of pure obsession to the point of delusion.
It likely depends on the unique qualities of your OCD. Someone who orders or has highly elaborate and numerous compulsions might become more compulsive with a stimulant. One would not want Monk to be speedy for instance :)
Posted by Chairman_MAO on February 11, 2004, at 10:11:01
In reply to Re: Chairman-do you have links to amphet for ocd, posted by Interject79 on February 10, 2004, at 23:07:31
Speed is only "speedy" at the wrong dosage. A popular pastime in the 1950s for yound people was to take a "Bennie", relax, and go for a trip in the convertable to the beach. I've seen video of it. Most people have no idea exactly how utterly wrong most of the drug propaganda is--even physicians believe it these days. Pathetic.
Posted by Interject79 on February 11, 2004, at 10:39:40
In reply to Re: Chairman-do you have links to amphet for ocd » Interject79, posted by Chairman_MAO on February 11, 2004, at 10:11:01
That's right, or if taken for the wrong reason. I take a stimulant and can easily take a peaceful nap; my roommate takes it and is intolerably wired. There are a lot of misconceptions about the safety of stimulants. The stimulants used today are safe and effective when used properly, as evinced by countless longitudinal studies.
This is the end of the thread.
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