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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by nlensing on January 15, 2006, at 1:01:10
I suffer from a wierd obsession and phobia. Corners and walls. I also suffer from GAD, SAD, Depression and worst of all I have a nervous eyebrow twitch. Clonidine helped a little bit for the twitch but now I'm obsessing about that. I've been on every med known to man, Prozac, Paxil, Celexa, Lexapro, Zoloft, Zymbalta, Remeron, Buspar, Loranzapam, Lithium, and nothings seemed to help. I'm currently on effexor, lithium, remeron, and clonidine and I feel worse now than I ever have in my life. HELP!
Posted by mogger on January 15, 2006, at 2:12:38
In reply to Ready to die cause of ocd, posted by nlensing on January 15, 2006, at 1:01:10
Hi there,
I was in the same situation (I have ocd and depression) you were in, I had tried all those meds with no improvement. My doctor then tried me on Lamictal and it has been a life changer honestly. It has helped with my ocd and depression and he added Zoloft and buspar and rememeron and they actually began to work with the lamictal as a base. Can you ask your doctor about Lamictal? I am on 300mg which I take at bed time. I have no side effects from it, i was agitated going up on it but that soon faded. Please have hope, I was literally in the same situation you were in. It is worth asking your doctor about, you have nothing to lose. Please don't hesitate to ask me questions about my experience, I would be happy to, hang in there, there is hope I promise,
mogger
Posted by mogger on January 15, 2006, at 2:15:07
In reply to Ready to die cause of ocd, posted by nlensing on January 15, 2006, at 1:01:10
Specifically,
Lamictal has "calmed my brain down" literally. It helps my mind reset as opposed to snagging constantly and then building and building. There is a release from my obsessions, please hang in there,
mogger
Posted by krybrahaha78 on January 15, 2006, at 2:42:40
In reply to Re: Ready to die cause of ocd, posted by mogger on January 15, 2006, at 2:15:07
have you tried Luvox? This med seems more superior for OCD than the other SSRI's---well to me anyways...
Posted by yxibow on January 15, 2006, at 4:16:13
In reply to Re: Ready to die cause of ocd, posted by krybrahaha78 on January 15, 2006, at 2:42:40
> have you tried Luvox? This med seems more superior for OCD than the other SSRI's---well to me anyways...
I would second the Luvox as being more superior than other SSRIs for OCD from my experience, but you may have to dial as high as 400mg/dy split in two.
As for the eyebrow twitch, that may or may not be curable by medication, but more by psychotherapy and relaxation. As for other medical options for it, Klonopin would probably be the most reductive of spasms for it. If it is really so severe that it genuinely interferes with daily life, alternating Botox A and B injections could stop it but you might suffer from some slight eyebrow droop.
For the GAD, there are other benzodiazepines you havent tried, like Valium or Serax. Effexor has been approved for SAD but it may complicate your GAD more than something like Cymbalta, which you have indicated you've tried, although I dont know at what dosage.
If you are truly suicidal I would seriously consider an inpatient voluntary visit. There is nothing that can't be mitigated at least partially and there are nearly no phobias that someone else hasn't experienced.
You haven't indicated that you have tried any of the antipsychotics, especially some of the atypical antipsychotics that affect mood to a varying degree, such as Zyprexa.
If none of the above works, the final treatment options are MAOIs, which will require a strict diet. If you are not in the US, you are luckier because some countries have approved RIMAs which are MAOIs that have few diet restrictions. I don't know if they can be imported into the US or not.
To better health.
Cheers
-- Jay
Posted by fires on January 15, 2006, at 12:13:21
In reply to Ready to die cause of ocd, posted by nlensing on January 15, 2006, at 1:01:10
>>and worst of all I have a nervous eyebrow twitch.
Are you sure it's not:
Benign fasciculation syndrome (BFS) is a neurological disorder characterized by fasciculation of various voluntary muscles in the body. The twitching can occur in any voluntary muscle group but is *most common in the eyelids*, arms, legs, and feet. Even the tongue is often affected. The twitching may be occasional or may go on nearly continuously. Any intentional movement of the involved muscle causes the fasciculations to cease immediately, but may restart once the muscle is at rest again.
More info.:
http://en.wikipedia.org/wiki/Benign_fasciculation_syndrome
Posted by john berk on January 15, 2006, at 13:48:52
In reply to Ready to die cause of ocd, posted by nlensing on January 15, 2006, at 1:01:10
Hey,Hi,
i have ocd also, since age 12, it was worse in my early teens, but lately i am doing better with the help of cognitive behavioral therapy, and low dose of prozac, plus klonopin as needed!i have found klonopin to be a life-saver, it reduces bad obsessive periods, and can definetly help with gad, possibly depression, and def ocd!!!
i belong to the ocd-support@yahoogroups.com, they have been talking alot about glutamate dysfunction in ocd, a drug called "namenda" shows alot of promise in ocd and anxiety disorders!!
maybe you can ask your doctor about it, i am going to find out fron my p-doc next month!!
good luck, peace...john
Posted by linkadge on January 15, 2006, at 14:14:04
In reply to Re: Ready to die cause of ocd » nlensing, posted by john berk on January 15, 2006, at 13:48:52
If it is a glutamatergic dysfunction, then this would give some credit to why some have found lamotrigine helpfull.
Linkadge
Posted by john berk on January 15, 2006, at 14:30:39
In reply to Re: Ready to die cause of ocd, posted by linkadge on January 15, 2006, at 14:14:04
Hi Link
good point, i didn't have knowledge of lamictal,
it is a glutamate inhibitor,[i just did a little homework, lol] thus possibly the help in ocd!! i have a friend with ocd on lamictal,
but he is also bi-polar, i just thought it was a good mood stabilzer, thanks for the tip...john
Posted by ed_uk on January 15, 2006, at 16:29:30
In reply to Re: Ready to die cause of ocd » linkadge, posted by john berk on January 15, 2006, at 14:30:39
Hi John
This may be of interest........
Memantine (Namenda, Ebixa) for Treatment-Resistant OCD
http://ajp.psychiatryonline.org/cgi/content/full/162/11/2191-a
Take care
Ed
Posted by ed_uk on January 15, 2006, at 16:36:10
In reply to Re: Ready to die cause of ocd » linkadge, posted by john berk on January 15, 2006, at 14:30:39
http://ajp.psychiatryonline.org/cgi/content/full/162/11/2191-a
Sorry for the double post. I forgot to change the subject.
Ed
Posted by ed_uk on January 15, 2006, at 16:44:00
In reply to Re: Ready to die cause of ocd » linkadge, posted by john berk on January 15, 2006, at 14:30:39
Psychopharmacology (Berl). 2005 Dec 22;:1-3
N-acetylcysteine augmentation in serotonin reuptake inhibitor refractory obsessive-compulsive disorder.Lafleur DL, Pittenger C, Kelmendi B, Gardner T, Wasylink S, Malison RT, Sanacora G, Krystal JH, Coric V.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
RATIONALE: Dysfunction of glutamatergic neurotransmission has been implicated in the pathophysiology of obsessive-compulsive disorder (OCD) and recent clinical reports suggest that some glutamate modulating agents are efficacious in the treatment of this disorder. N-acetylcysteine (NAC) is a readily available amino acid compound that is thought to attenuate glutamatergic neurotransmission. NAC may be useful in treating psychiatric disorders involving glutamatergic dysfunction such as OCD. OBJECTIVES: To examine the efficacy of augmentation with NAC in a patient with serotonin reuptake inhibitor (SRI)-refractory OCD. METHODS: A patient with SRI-refractory OCD was treated with an off-label use of NAC augmentation of fluvoxamine over several weeks. RESULTS: NAC augmentation of fluvoxamine resulted in a marked decrease in Yale-Brown Obsessive Compulsive Scale (Y-BBOCS) score and a clinically significant improvement in OCD symptoms. CONCLUSIONS: NAC augmentation was effective in treating SRI-refractory OCD in this single case. Further research is warranted to investigate the use of NAC and other glutamate modulating agents in the treatment of OCD.
................................................................................................................................................
CNS Spectr. 2005 Oct;10(10):820-30.
The role of glutamate in anxiety and related disorders.
Cortese BM, Phan KL.
Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA.
Anxiety, stress, and trauma-related disorders are a major public health concern in the United States. Drugs that target the gamma-aminobutyric acid or serotonergic system, such as benzodiazepines and selective serotonin reuptake inhibitors, respectively, are the most widely prescribed treatments for these disorders. However, the role of glutamate in anxiety disorders is becoming more recognized with the belief that drugs that modulate glutamatergic function through either ionotropic or metabotropic glutamate receptors have the potential to improve the current treatment of these severe and disabling illnesses. Animal models of fear and anxiety have provided a method to study the role of glutamate in anxiety. This research has demonstrated that drugs that alter glutamate transmission have potential anxiolytic action for many different paradigms including fear-potentiated startle, punished responding, and the elevated plus maze. Human clinical drug trials have demonstrated the efficacy of glutamatergic drugs for the treatment of obsessive-compulsive disorder, posttraumatic stress disorder, generalized anxiety disorder, and social phobia. Recent data from magnetic resonance imaging studies provide an additional link between the glutamate system and anxiety. Collectively, the data suggest that future studies on the mechanism of and clinical efficacy of glutamatergic agents in anxiety disorders are appropriately warranted.
...................................................................................................................................................
Biol Psychiatry. 2005 Sep 1;58(5):424-8.
Riluzole (Rilutek) augmentation in treatment-resistant obsessive-compulsive disorder: an open-label trial.Coric V, Taskiran S, Pittenger C, Wasylink S, Mathalon DH, Valentine G, Saksa J, Wu YT, Gueorguieva R, Sanacora G, Malison RT, Krystal JH.
Department of Psychiatry, Yale University School of Medicine and Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519, USA. vladimir.coric@yale.edu
BACKGROUND: Most patients with obsessive-compulsive disorder (OCD) show only partial reduction of symptoms with standard therapy. Recent imaging data suggests glutamatergic dysfunction in the corticostriatal pathway in OCD. We investigated the efficacy of augmentation therapy with riluzole, a glutamate-modulating agent, in treatment-resistant OCD. METHODS: Thirteen patients aged between 18 and 65 years with a primary diagnosis of OCD that had proven resistant to standard treatment were treated with the addition of riluzole to their existing pharmacotherapy. Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Depression Inventory (HAM-D), and Hamilton Anxiety Inventory (HAM-A) scores were obtained weekly. RESULTS: Thirteen treatment-resistant OCD patients received riluzole 50 mg twice a day. Y-BOCS scores improved significantly over time. Of 13 patients, 7 (54%) demonstrated a >35% reduction in Y-BOCS scores, and 5 (39%) were categorized as treatment responders. HAM-D and HAM-A scores for the group also significantly improved over time. Riluzole was well tolerated with no serious adverse effects noted. CONCLUSIONS: Riluzole appears to have significant antiobsessional, antidepressant, and antianxiety properties. The addition of this agent may be of practical clinical benefit in patients with OCD.
Ed
Posted by linkadge on January 15, 2006, at 17:06:47
In reply to More on glutamate and OCD » john berk, posted by ed_uk on January 15, 2006, at 16:44:00
Good ol magneisum and vitamin C, and zinc, might also help in this regard.
Linkadge
Posted by Phillipa on January 15, 2006, at 19:06:18
In reply to Re: More on glutamate and OCD, posted by linkadge on January 15, 2006, at 17:06:47
Luvox works too. Fondly, Phillipa
Posted by john berk on January 15, 2006, at 19:14:25
In reply to Re: Ready to die cause of ocd » john berk, posted by ed_uk on January 15, 2006, at 16:29:30
Hi Ed,
that was an incredible amount of information, thank you for your time,
namenda, [memantine] and riluzole or both high on my list of things to ask my p-doc about!!
i keep reading more and more about glutamte and it's role in ocd pathology, even dr. jenike, world renowned ocd specialist, [and a contributor to the support group] often mentions ongoing trials of namenda!! very much appreciated, take care ed...john
Posted by john berk on January 15, 2006, at 19:17:22
In reply to Re: More on glutamate and OCD, posted by linkadge on January 15, 2006, at 17:06:47
Hi link, i am actually taking magnesium taurate and zinc, took some an hour ago, thanks so much, i truly beleive magnesium is a wonder nutrient, it is found to be low in almost all uni-polar depressives..john
Posted by john berk on January 15, 2006, at 19:21:14
In reply to Re: More on glutamate and OCD, posted by Phillipa on January 15, 2006, at 19:06:18
Hey phillipa,
how are you? i tryed luvox 2 years ago, i thought it worked real well, but for me it was very stimulating, for most, it is sedating, so i had to wean off, even 100 mgs. was too much! thanks,
your friend...john
Posted by linkadge on January 15, 2006, at 19:43:06
In reply to Re: More on glutamate and OCD » linkadge, posted by john berk on January 15, 2006, at 19:17:22
Yeah, glutamate is high in depression.
Magnesium has helped me a lot too. It has some immediate benifits and others that you reap over time.
You loose a lot with stress.
Linkadge
Posted by Phillipa on January 15, 2006, at 21:11:44
In reply to Re: More on glutamate and OCD, posted by linkadge on January 15, 2006, at 19:43:06
Link what about diarrhea magnesium can cause it. Fondly, Phillipa
Posted by linkadge on January 16, 2006, at 8:19:50
In reply to Re: More on glutamate and OCD » linkadge, posted by Phillipa on January 15, 2006, at 21:11:44
Probably get redirected, but spreading doses out, and taking it with food has helped in that regard.
(for me at least)Linkadge
Posted by ed_uk on January 16, 2006, at 13:47:57
In reply to Re: Ready to die cause of ocd » ed_uk, posted by john berk on January 15, 2006, at 19:14:25
Hi J
Namenda is a lot more affordable than Rilutek. Rilutek is horrendously expensive!
Take care
Ed
Posted by john berk on January 16, 2006, at 14:20:47
In reply to Re: Ready to die cause of ocd » john berk, posted by ed_uk on January 16, 2006, at 13:47:57
Thanks Ed,
With the fact that my insurance will no longer cover my klonopin[ or generic clonazepam] or brand name prozac, money is a great concern, think i will ask about namenda!
take care Ed...john
Posted by yxibow on January 16, 2006, at 19:26:03
In reply to Re: Ready to die cause of ocd » ed_uk, posted by john berk on January 16, 2006, at 14:20:47
> Thanks Ed,
> With the fact that my insurance will no longer cover my klonopin[ or generic clonazepam] or brand name prozac, money is a great concern, think i will ask about namenda!
> take care Ed...johnThat's rather odd that they won't cover clonazepam but will cover namenda (Memantine) which is an expensive new prescription.
Most benzodiazepines are dirt cheap these days and some are below copay. Diazepam (Valium) is even cheaper than Clonazepam (Klonopin) on cash pay, just checking Walgreen's for example. Drugstore.com is even cheaper. Don't be quick to abandon them before you check your prices and needs.
Posted by john berk on January 16, 2006, at 21:14:50
In reply to Re: Ready to die cause of ocd -- benzo prices » john berk, posted by yxibow on January 16, 2006, at 19:26:03
Hi, Thanks,
no, i would never even consider stopping my clonazepam, it was a life-saver, [plus i prob am addicted to a degree now after 4 years, lol] but i will be interested to see if namenda is covered by my health plan!!
i have a walgreens close by, i am going to check the price list, thanks again yxibow, take care..john
Posted by Phillipa on January 16, 2006, at 21:17:48
In reply to Re: Ready to die cause of ocd -- benzo prices » yxibow, posted by john berk on January 16, 2006, at 21:14:50
Someone told me you can use Cosco pharmacy without becoming a member. just say you're using the pharmacy. Supposed they are the cheapest of all. Any feed back on this? Fondly, Phillipa
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