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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by jerrympls on December 28, 2004, at 17:56:11
HI all-
My brother has OCD and has for 15 years but never got treatment. His symptoms are obessive thinking, anxiety, ritualistic behaviors (turning the lights on and off a certain number of times, etc). He called the other day and said that he's sick of having to do all these behaviors, that they interfere with his life tremendously and wants to start a medication. He talks to his doctor tomorrow and I suggested LUVOX. I know all SSRIs work the same - but are any more effective for OCD than others?
Thanks much
Jerry
Posted by jujube on December 28, 2004, at 18:28:58
In reply to Best SSRI for OCD? Need help for relative...., posted by jerrympls on December 28, 2004, at 17:56:11
Hi Jerry!
I am by no means an expert on meds for OCD, but I have heard that Luvox is supposed to be a good one for OCD. If your brother was willing to try a TCA, I have read that Anafranil is supposed to be the gold standard for OCD. I am sure others with more knowledge and experience will provide you with more suggestions.
BTW, how are you doing? Did you manage to get home to spend Christmas with your family? If so, I hope you had a nice time. It is nice of you to try to help your brother. Hope you are hanging in there.
Take care Jerry, and be good to yourself.
Tamara
> HI all-
>
> My brother has OCD and has for 15 years but never got treatment. His symptoms are obessive thinking, anxiety, ritualistic behaviors (turning the lights on and off a certain number of times, etc). He called the other day and said that he's sick of having to do all these behaviors, that they interfere with his life tremendously and wants to start a medication. He talks to his doctor tomorrow and I suggested LUVOX. I know all SSRIs work the same - but are any more effective for OCD than others?
>
> Thanks much
> Jerry
Posted by jerrympls on December 28, 2004, at 18:33:38
In reply to Re: Best SSRI for OCD? Need help for relative.... » jerrympls, posted by jujube on December 28, 2004, at 18:28:58
> Hi Jerry!
>
> I am by no means an expert on meds for OCD, but I have heard that Luvox is supposed to be a good one for OCD. If your brother was willing to try a TCA, I have read that Anafranil is supposed to be the gold standard for OCD. I am sure others with more knowledge and experience will provide you with more suggestions.
>
> BTW, how are you doing? Did you manage to get home to spend Christmas with your family? If so, I hope you had a nice time. It is nice of you to try to help your brother. Hope you are hanging in there.
>
> Take care Jerry, and be good to yourself.
>
> Tamara
>Hi Tamara-
I ended up staying home for xmas. It's a long story but I don't really regret it. Anyway, my brother was on Anafranil years ago but it was so sedating and caused so much weight gain he swore of meds. That's why I'm steering him to an SSRI - not as dirty as Anafranil. Thanks for your post!
Jerry
Posted by jujube on December 28, 2004, at 18:48:43
In reply to Re: Best SSRI for OCD? Need help for relative.... » jujube, posted by jerrympls on December 28, 2004, at 18:33:38
Jerry,
FYI
http://www.wistv.com/Global/story.asp?S=1515319&nav=0RaPIygo
http://psychcentral.com/library/ocd_meds.htm
Posted by celticmom on December 29, 2004, at 13:03:59
In reply to Best SSRI for OCD? Need help for relative...., posted by jerrympls on December 28, 2004, at 17:56:11
My DS was on Luvox for a while and it did wonders for his anxiety and OCD. He'd still be on it if he didn't have a sensitivity to SSRIs.
Posted by yxibow on December 29, 2004, at 15:19:19
In reply to Best SSRI for OCD? Need help for relative...., posted by jerrympls on December 28, 2004, at 17:56:11
> HI all-
>
> My brother has OCD and has for 15 years but never got treatment. His symptoms are obessive thinking, anxiety, ritualistic behaviors (turning the lights on and off a certain number of times, etc). He called the other day and said that he's sick of having to do all these behaviors, that they interfere with his life tremendously and wants to start a medication. He talks to his doctor tomorrow and I suggested LUVOX. I know all SSRIs work the same - but are any more effective for OCD than others?
>
> Thanks much
> JerryAll SSRIs are related to each other in some ways... they each affect a series of transmitters in different amounts. Luvox was the only one initially to get labelled for OCD use, Prozac followed. However all were used off-label. Anafranil, introduced in the US in 1990 though available ages before in other countries, is a tricyclic which some consider an SSRI, and some consider a gold standard for severe OCD. It also comes with some more unpleasant side effects as a tricyclic and an older drug, but thats a tradeoff. I've personally used Luvox and must say that it does do work on ruminative thinking, but for me it was more a choice at the time that I wanted an SSRI which was least activating (I have anxiety).. other SSRIs are more activating with Prozac probably being at the top.
So... you have choices to make... sleep->active, weight gain->weight loss, generic->currently patented (and pricier), side effects->less. Beyond those (and agreeable a lot of factors).. I would say they all work to some degree for OCD, its a matter of dosing. But if I picked one out of a hat.. I suppose I'd say (generic) Luvox. But thats just my experience. Yours is to discuss those variables with your doctor.
And as a postscript, as a lifetime OCD sufferer (as most are), it follows you wherever you go, you just learn to turn it off and move on. So, its not just drugs, but behaviour therapy has to follow along with medication -- medication is a tool to take the "ahh" out of the agony so one can focus on fading away the compulsions that come with the obsessions.
best wishes.
Posted by jerrympls on December 29, 2004, at 15:34:43
In reply to Re: Best SSRI for OCD? Need help for relative...., posted by yxibow on December 29, 2004, at 15:19:19
> > HI all-
> >
> > My brother has OCD and has for 15 years but never got treatment. His symptoms are obessive thinking, anxiety, ritualistic behaviors (turning the lights on and off a certain number of times, etc). He called the other day and said that he's sick of having to do all these behaviors, that they interfere with his life tremendously and wants to start a medication. He talks to his doctor tomorrow and I suggested LUVOX. I know all SSRIs work the same - but are any more effective for OCD than others?
> >
> > Thanks much
> > Jerry
>
> All SSRIs are related to each other in some ways... they each affect a series of transmitters in different amounts. Luvox was the only one initially to get labelled for OCD use, Prozac followed. However all were used off-label. Anafranil, introduced in the US in 1990 though available ages before in other countries, is a tricyclic which some consider an SSRI, and some consider a gold standard for severe OCD. It also comes with some more unpleasant side effects as a tricyclic and an older drug, but thats a tradeoff. I've personally used Luvox and must say that it does do work on ruminative thinking, but for me it was more a choice at the time that I wanted an SSRI which was least activating (I have anxiety).. other SSRIs are more activating with Prozac probably being at the top.
>
> So... you have choices to make... sleep->active, weight gain->weight loss, generic->currently patented (and pricier), side effects->less. Beyond those (and agreeable a lot of factors).. I would say they all work to some degree for OCD, its a matter of dosing. But if I picked one out of a hat.. I suppose I'd say (generic) Luvox. But thats just my experience. Yours is to discuss those variables with your doctor.
>
> And as a postscript, as a lifetime OCD sufferer (as most are), it follows you wherever you go, you just learn to turn it off and move on. So, its not just drugs, but behaviour therapy has to follow along with medication -- medication is a tool to take the "ahh" out of the agony so one can focus on fading away the compulsions that come with the obsessions.
>
> best wishes.
>
Thank sso much for your post. I intend to get my brother into some sort of therapy after he's started the med. His doc prescribed Paxil - so I'm hoping that works for him. Is it true that SSRI dosages are usually higher than those for depression treatment? Also, my brother's very anxious about the medication working - and when it will kick in and give him some relief. I've told him it can be anywhere from 2 weeks to a month or two for full relief. I'm hoping he starts to feel some benefit within the first couple weeks. Also, I don't want to raise hi hopes by telling him that this will take his OCD away (which I kinda think he wants to hear) - do you have any advice as to how I should explain how he'll feel once it does kick in and work?
Thanks
Jerry
Posted by ed_uk on December 29, 2004, at 16:00:30
In reply to Re: Best SSRI for OCD? Need help for relative.... » yxibow, posted by jerrympls on December 29, 2004, at 15:34:43
Hi Jerry :-)
I really hope that you're feeling better. Have you decided to start metyrapone?
>His doc prescribed Paxil - so I'm hoping that works for him. Is it true that SSRI dosages are usually higher than those for depression treatment?
Yes, it's true! For OCD, 40-60mg Paxil is the norm. Paxil was effective for my OCD, I needed at least 40mg for a good effect.
>Also, my brother's very anxious about the medication working - and when it will kick in and give him some relief.
Oh, the long wait :-( SSRIs generally seem to take longer to help OCD than they do to help depression. Improvement can take many weeks, it takes about 12 weeks at 40mg Paxil for me to achieve good suppression of my OCD. Although further improvement can occur after 12 weeks if a med is working, if a med has not had any effect against OCD after 12 weeks at a high dose then it's time to change the med.
>do you have any advice as to how I should explain how he'll feel once it does kick in and work?
For me........
Stage 1. Obsessional thoughts start to seem less important ie. when they do occur, they cause less anxiety and distress. (It's like... you don't care as much about your obsessions anymore). The need to perform compulsions is therefore reduced.
Stage 2. Obsessional thoughts occur less frequently. Less time is spent obsessing and less time is spent performing compulsions.
Good luck to you and your brother...
Ed.
Posted by jerrympls on December 29, 2004, at 16:58:09
In reply to Re: Best SSRI for OCD? Need help for relative.... » jerrympls, posted by ed_uk on December 29, 2004, at 16:00:30
Thanks Ed for the info - I'll be sure to pass it on!
Yes, I've decided to start the Metyrapone - however, it takes a call from my doctor and pharmacist to Novartis to get a supply of the med. Apparently they only supply this med on a case by case basis - it's not a med that pharmacies have readily on their shelves.
So hopefully in the next week I'll be starting it.
I'll keep you posted.
Jerry
Posted by ed_uk on December 29, 2004, at 17:07:58
In reply to Re: Best SSRI for OCD? Need help for relative.... » ed_uk, posted by jerrympls on December 29, 2004, at 16:58:09
Good Luck Jerry!
Keep us posted :-)
Regards,
Ed.
Posted by don_bristol on December 31, 2004, at 13:59:57
In reply to Re: Best SSRI for OCD? Need help for relative...., posted by yxibow on December 29, 2004, at 15:19:19
Personally, I reckon Luvox has rather too many side effects (relative to the other SSRIs) in the sort of dose needed to deal with OCD.
Maybe be best to start with a very "clean"SSRI like escitalopram in order to get good compliance despite side effects. Maybe prozac if escitalopram doesn't work. Next trial might something very different like anafranil before coming back to the ssris. My last choice would be Paxil.
> And as a postscript, as a lifetime OCD sufferer (as most are), it follows you
> wherever you go, you just learn to turn it off and move on. So, its not
> just drugs, but behaviour therapy has to follow along with medication --
> medication is a tool to take the "ahh" out of the agony so one can focus
> on fading away the compulsions that come with the obsessions.Yes, as you advise, meds are not the whole answer. I agree that therapy is the real trick. The meds can give you a bit of respite and make you strong enough to do the therapy.
This is always a good article for OCD meds (even if it is a bit dated now)
http://www.ocfoundation.org/ocf1050a.htmGuidelines 3 and 4A in Treatment of Obsessive-Compulsive Disorder in the Expert Consensus Guideline Series is to do with meds.
http://www.psychguides.com/ocgl.htmlHTH
Posted by yxibow on January 3, 2005, at 17:34:38
In reply to Re: Best SSRI for OCD? Need help for relative.... » yxibow, posted by jerrympls on December 29, 2004, at 15:34:43
Sorry, I hadnt followed the board for this period over the new year
> Thank sso much for your post. I intend to get my brother into some sort of therapy after he's started the med.
Excellent... when both go together, success rates are definately improved... I should say rates of returning to a healthy structured life... OCD still regrettably is to the best of our knowledge a lifetime condition but most with it, with good treatment can control its cycles through life.
His doc prescribed Paxil - so I'm hoping that works for him. Is it true that SSRI dosages are usually higher than those for depression treatment?
Also, my brother's very anxious about the medication working - and when it will kick in and give him some relief. I've told him it can be anywhere from 2 weeks to a month or two for full relief.This is true... sometimes doctors prescribe a small dose of a benzodiazepine for a temporary basis, like Ativan or Klonopin inbetween.
I'm hoping he starts to feel some benefit within the first couple weeks. Also, I don't want to raise hi hopes by telling him that this will take his OCD away (which I kinda think he wants to hear) - do you have any advice as to how I should explain how he'll feel once it does kick in and work?
SSRIs, at least in my case/view, are a very subtle medication.. you dont know how you feel ironically unless you remove the drug. Sometimes there can be a temporary period of manic happiness, Prozac comes to mind, in some people. In general... the feeling is indirect. Rumination thinking may dissipate. One might "forget" to wash ones hands after touching something, etc.
I would agree, to not get ones hopes high over any medication. There are other alternatives. If, and I dont know if your brother has been diagnosed with an extreme end of the "YBOCS" scale of OCD, sometimes doctors will augment SSRIs with a small dose of a neuroleptic to improve effectiveness. But generally, its just a wait and see... they can take up to 12 weeks to build a full neurochemical change.
-- Best for 2005
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