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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Kimbersaur on December 3, 2006, at 1:42:20
Hi guys, I was hoping that I could get some medication advice. I'll try to keep it short.
I am currently on 50mg Seroquel and 250mg Lamictal for OCD and Bipolar disorder (although I am REALLY starting to doubt that I'm Bipolar). A year or two ago I was also on Effexor and a lot more Seroquel, but I stopped the Effexor because of sexual side-effects and lowered the Seroquel because I was sick of the sedation. My OCD symptoms got somewhat worse, but I've been able to deal with them just fine on this low dose- until a couple of weeks ago. I've started having some really disturbing intrusive thoughts (my OCD was mainly just rituals before), and they are getting worse and worse!
So, I am thinking of trying something new, but I am afraid of having the sexual side-effects come back. I think that SSRI's are a bad idea, because Prozac made me paranoid and Paxil made me manic. What else can I try for OCD that wont give me sexual side-effects? My mom suggested Cymbalta (she's a doctor) but I am afraid it will make me anorgasmic or manic or something. Is Anafranil a good option? Abilify maybe?
Posted by yxibow on December 3, 2006, at 5:58:02
In reply to OCD help, posted by Kimbersaur on December 3, 2006, at 1:42:20
> Hi guys, I was hoping that I could get some medication advice. I'll try to keep it short.
>
> I am currently on 50mg Seroquel and 250mg Lamictal for OCD and Bipolar disorder (although I am REALLY starting to doubt that I'm Bipolar). A year or two ago I was also on Effexor and a lot more Seroquel, but I stopped the Effexor because of sexual side-effects and lowered the Seroquel because I was sick of the sedation. My OCD symptoms got somewhat worse, but I've been able to deal with them just fine on this low dose- until a couple of weeks ago. I've started having some really disturbing intrusive thoughts (my OCD was mainly just rituals before), and they are getting worse and worse!
>
> So, I am thinking of trying something new, but I am afraid of having the sexual side-effects come back. I think that SSRI's are a bad idea, because Prozac made me paranoid and Paxil made me manic. What else can I try for OCD that wont give me sexual side-effects? My mom suggested Cymbalta (she's a doctor) but I am afraid it will make me anorgasmic or manic or something. Is Anafranil a good option? Abilify maybe?
I was going to suggest Luvox because I felt it really did help OCD and clamped down on intrusive thoughts much better, however you have related that you react differently to SSRIs which may be related to that you have BP or a BP related concomitant, at least to a degree.
Anafranil is sort of a gold standard / dart gun for tough OCD cases. You have you be prepared for the side effects of a tricyclic, which can include possible sedation and sweating from what I recall about Anafranil. It can also cause sexual side effects I think because it is a partial SSRI -- some doctors augment this with a slight amount of Wellbutrin if this is really an issue. However I don't know the dopamine angle here vis-a-vis (possible) BP.
Another choice is an SSRI + a low dose atypical neuroleptic, however since the SSRIs have seemed to make you worse, it would probably be just a low dose neuroleptic. I'm not sure if they have ever combined Anafranil (which is technically just known as an SRI) + a low dose atypical.
Seroquel is the most sedating of all neuroleptics, new and old, this is true.Depending on how you react to neuroleptics, you may or may not find Abilify or Geodon to cause some akathisia (a side effect, not anxiety, but it feels like you want to crawl up the walls -- you can take anticholinergics or beta blockers or benzodiazepines to control this to a degree).
Some people react completely the opposite and find especially Geodon somewhat sedating.
-- Jay
Posted by Phillipa on December 3, 2006, at 11:40:46
In reply to Re: OCD help, posted by yxibow on December 3, 2006, at 5:58:02
They claim all the SSRI's help with OCD but luvox is approved in the US for OCD but you don't want an SSRI which leaves anafranil? Love Phillipa
Posted by Kimbersaur on December 3, 2006, at 18:40:52
In reply to Re: OCD help, posted by yxibow on December 3, 2006, at 5:58:02
> > Hi guys, I was hoping that I could get some medication advice. I'll try to keep it short.
> >
> > I am currently on 50mg Seroquel and 250mg Lamictal for OCD and Bipolar disorder (although I am REALLY starting to doubt that I'm Bipolar). A year or two ago I was also on Effexor and a lot more Seroquel, but I stopped the Effexor because of sexual side-effects and lowered the Seroquel because I was sick of the sedation. My OCD symptoms got somewhat worse, but I've been able to deal with them just fine on this low dose- until a couple of weeks ago. I've started having some really disturbing intrusive thoughts (my OCD was mainly just rituals before), and they are getting worse and worse!
> >
> > So, I am thinking of trying something new, but I am afraid of having the sexual side-effects come back. I think that SSRI's are a bad idea, because Prozac made me paranoid and Paxil made me manic. What else can I try for OCD that wont give me sexual side-effects? My mom suggested Cymbalta (she's a doctor) but I am afraid it will make me anorgasmic or manic or something. Is Anafranil a good option? Abilify maybe?
>
>
> I was going to suggest Luvox because I felt it really did help OCD and clamped down on intrusive thoughts much better, however you have related that you react differently to SSRIs which may be related to that you have BP or a BP related concomitant, at least to a degree.
>
>
> Anafranil is sort of a gold standard / dart gun for tough OCD cases. You have you be prepared for the side effects of a tricyclic, which can include possible sedation and sweating from what I recall about Anafranil. It can also cause sexual side effects I think because it is a partial SSRI -- some doctors augment this with a slight amount of Wellbutrin if this is really an issue. However I don't know the dopamine angle here vis-a-vis (possible) BP.
>
>
> Another choice is an SSRI + a low dose atypical neuroleptic, however since the SSRIs have seemed to make you worse, it would probably be just a low dose neuroleptic. I'm not sure if they have ever combined Anafranil (which is technically just known as an SRI) + a low dose atypical.
>
>
> Seroquel is the most sedating of all neuroleptics, new and old, this is true.
>
> Depending on how you react to neuroleptics, you may or may not find Abilify or Geodon to cause some akathisia (a side effect, not anxiety, but it feels like you want to crawl up the walls -- you can take anticholinergics or beta blockers or benzodiazepines to control this to a degree).
>
> Some people react completely the opposite and find especially Geodon somewhat sedating.
>
> -- Jay
Thank you so much for the lengthy response! I have a few questions:1. Are Tricyclics really unhealthy or something? I mean, are they like a last resort? It just seems like I've heard a lot of bad stuff about them.
2. Have you heard of any success with using Abilify for OCD?
3. What do you think about Cymbalta? My mom is kind of pushing for it, and I've heard that it has less of a chance for sexual side-effects in women.
I would love some input from anyone- I'm starting to really obsess about obsessing!
Posted by jonathanupr on December 3, 2006, at 18:50:45
In reply to Re: OCD help, posted by Kimbersaur on December 3, 2006, at 18:40:52
along my path in looking for a solution to the OCD disorder that I have, the best solutions to such disorder has pretty much been Lexapro....I take it at around 5 mgs, and take a 3 mg dose of Gabitril as well (which helps with some irritability issues I get from the Adderall that I take).
My experience with Lamictal is that it made my OCD so much worse when I was on an nor-epinephrine reuptake inhibitor or a dopamine agonist (really bad days). The reason for this probably lies in Lamictal's indirect effects on dopamine release (as it pretty much takes the glutamate out of the picture, this could be one cause). So if I were in your shoes I'd probably rule out any of the TCAs (as they are both serotonin and nor-epinephrine reuptake inhibitors), as well as Cymbalta (as it is a potent SNRI as well).
A low dose of an SSRI wouldn't hurt to try...
Posted by Kimbersaur on December 3, 2006, at 18:59:25
In reply to Re: OCD help, posted by jonathanupr on December 3, 2006, at 18:50:45
> along my path in looking for a solution to the OCD disorder that I have, the best solutions to such disorder has pretty much been Lexapro....I take it at around 5 mgs, and take a 3 mg dose of Gabitril as well (which helps with some irritability issues I get from the Adderall that I take).
>
> My experience with Lamictal is that it made my OCD so much worse when I was on an nor-epinephrine reuptake inhibitor or a dopamine agonist (really bad days). The reason for this probably lies in Lamictal's indirect effects on dopamine release (as it pretty much takes the glutamate out of the picture, this could be one cause). So if I were in your shoes I'd probably rule out any of the TCAs (as they are both serotonin and nor-epinephrine reuptake inhibitors), as well as Cymbalta (as it is a potent SNRI as well).
>
> A low dose of an SSRI wouldn't hurt to try...Gosh, it feels like there is no solution. Effexor actually helped me with my OCD while I was on Lamictal, I just couldn't tolerate the anorgasmia anymore. My mom just brought me home some samples of Cymbalta and I just can't decide if I want to try it or not.
Posted by Phillipa on December 3, 2006, at 19:35:00
In reply to Re: OCD help, posted by Kimbersaur on December 3, 2006, at 18:40:52
This is heresay but the TCA's have worse side effects. And they are more dangerous as a person can OD on them from what I've heard. Dry mouth, weight gain bad, taccycardia or cardiac symptoms. I tried one once and only once I hated it. But some people love them as a combo with SSRIs. Cymbalta has norepenephine in it too. It's about the same as effexor but supposed milder with less side effects. I took it twice it didn't help me but that me and I did take 60mg the first time for over 6months. Love Phillipa
Posted by theo on December 3, 2006, at 21:49:33
In reply to OCD help, posted by Kimbersaur on December 3, 2006, at 1:42:20
What about Luvox (Fluvoxamine). Since the name brand Luvox went of the market for no other reason than politics, doctors don't even mention the generic version since the drug reps aren't pushing it. You might start with the lowest dose, like 25mg, and go up from there if you need to. I'm thinking about trying it as Prozac seemed to make my OCD worse.
Posted by johnnyj on December 3, 2006, at 21:55:11
In reply to Re: OCD help » Kimbersaur, posted by theo on December 3, 2006, at 21:49:33
remeron made my obsessions worse and produced new ones too. That was on doses of 15 or 30 mg. Lower doses didn't seem to affect it much.
Nortyptline seems to make it worse also in addition to irritability.
Posted by yxibow on December 4, 2006, at 19:26:46
In reply to Re: OCD help, posted by Kimbersaur on December 3, 2006, at 18:59:25
> > along my path in looking for a solution to the OCD disorder that I have, the best solutions to such disorder has pretty much been Lexapro....I take it at around 5 mgs, and take a 3 mg dose of Gabitril as well (which helps with some irritability issues I get from the Adderall that I take).
> >
> > My experience with Lamictal is that it made my OCD so much worse when I was on an nor-epinephrine reuptake inhibitor or a dopamine agonist (really bad days). The reason for this probably lies in Lamictal's indirect effects on dopamine release (as it pretty much takes the glutamate out of the picture, this could be one cause). So if I were in your shoes I'd probably rule out any of the TCAs (as they are both serotonin and nor-epinephrine reuptake inhibitors), as well as Cymbalta (as it is a potent SNRI as well).
> >
> > A low dose of an SSRI wouldn't hurt to try...
>
> Gosh, it feels like there is no solution. Effexor actually helped me with my OCD while I was on Lamictal, I just couldn't tolerate the anorgasmia anymore. My mom just brought me home some samples of Cymbalta and I just can't decide if I want to try it or not.
Venlafaxine (Effexor) works a little differently and I think has been challenged against OCD. I currently take Cymbalta and it does cover my secondary depression but doesn't do a lot for obsessional/garbage-racist-spaghetti thoughts (not my personality, just nonsense in the mind -- actually the more you try to fight them the worse it is so I just let it float away.)
There's no harm in trying Cymbalta though I probably would start at a low dose of it to see if you are one of the people who can stand Effexor but not Cymbalta. (I'm the opposite, I think, though I also take benzodiazepines.) Cymbalta is a very subtle agent in my experience and can take a while for that "oh, its working" feeling. But as they say, your miles may vary.
Tricyclics do carry a burden of somewhat higher toxicity, but we're not talking barbiturate type issues. They can, on rare occasion, cause TD though that is not a common incident. Mainly they are more sedating, and less "clean" than SSRIs and do activate more than one transmitter and are more sedating. This sedation is part of the issue of extra toxicity since (and I'm not going to go there on this board, but you can guess that increases risks). They're generally antihistamines. They still have their use in modern psychiatry though they've been around for probably at least 30 years.
If Effexor really worked for you, you could discuss with your doctor about low dose Wellbutrin SR/XL augmentation for the sexual side effects.If an agent works well, I would go for it, but I know that sexual side effects can be as depressing as the agents we try to fight our problems with.
Its a tradeoff at times, and the side effects vary -- low dose SSRIs are actually used for people who have orgasmic experiences too fast, ironically.
Desvenlafaxine may be coming out in the next year, the metabolite of Effexor, yes, most likely just a patent extender, but who knows what it might do for Effexor takers.
Ultimately OCD help relies both on medication and behavioural therapy, though obsessive thinking is one of the harder ones to overcome.I assume you know about the OC Foundation, but have a look at their website if you dont, its a good stepping off place
www.ocfoundation.org
-- tidings
Jay
Posted by jonathanupr on December 5, 2006, at 5:02:54
In reply to Re: OCD help » Kimbersaur, posted by yxibow on December 4, 2006, at 19:26:46
If Effexor didn't make your OCD worse while you were on the Lamictal then the Cymbalta may be worth a try. Like said, I'd start out at a low dose on the Cymbalta if you were going to do it. Though, the Cymbalta is very much an SSRI as well, its side effects are just covered a bit by its NRI properties. What about a low dose of an SSRI? This is just my experience, but a low dose of Lexapro at 5 mgs has made my OCD very bearable, and I know that with the combination of the Lamictal and the Lexapro .....that the Lamictal will make the Lexapro work better at a lower dose, that's been my experience as well.
This is the end of the thread.
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