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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 4 to 28 of 28. Go back in thread:
Posted by BRC on June 29, 2009, at 12:23:12
In reply to Re: Intrusive OCD thoughts? » BRC, posted by yxibow on June 28, 2009, at 16:23:24
Yea, My OCD thoughts are not repetive thoughts that I can't get out of my head. Rather they are scary or frightening thoughts that cause anxiety and discomfort. Even though I know they are OCD thoughts they still envoke the emotions and senses when I have them.
Yea I tried Anafranil for a long time. Doc. switched to Luvox b/c of less side effects. I have pondered the idea of a small dose of the newer atypical ant-psychotic meds since they are intended for correcting thoughts. But I am afraid of the side effects.
BRC
Posted by bleauberry on June 29, 2009, at 19:55:06
In reply to Intrusive OCD thoughts?, posted by BRC on June 28, 2009, at 11:53:08
I've had the best response to OCD intrusive thoughts with a serotonin-norepinephrine mix, for example milnacipran, or lexapro+nortriptyline, or parnate. It would seem logical to expect a ssri med or benzo would do the trick, but I found that a multispectrum approach works tons better. The only hard part is that during the first days the symptoms are worse, so it is extremely important to start with very small doses and know that there will be a period of a few days of worsening and to expect it, but that following that is serene.
I found antipsychotics either did not help, only blunted it somewhat but didn't really get to the heart of it, or worsened it.
Serotonin alone, bad. Norepinephrine alone, bad. Gaba alone, bad. An equal mix works awesome.
That does NOT include Cymbalta or Effexor. Those are almost purely serotonin, despite their nearly disingenuise claim of being SNRIs.
Posted by Frustratedmama on June 29, 2009, at 21:07:14
In reply to Re: Intrusive OCD thoughts?, posted by bleauberry on June 29, 2009, at 19:55:06
bb- would you consider pristiq to be in this loop of snri's? Curious cause i was considering adding it to the gabapentin....
Posted by yxibow on June 30, 2009, at 3:05:20
In reply to Re: Intrusive OCD thoughts?, posted by bleauberry on June 29, 2009, at 19:55:06
> I've had the best response to OCD intrusive thoughts with a serotonin-norepinephrine mix
....well that would be Anafranil too. I can't go over 75 as the NE appears to be too much for me these days unlike in the past.
Posted by Phillipa on June 30, 2009, at 19:58:00
In reply to Re: Intrusive OCD thoughts? » bleauberry, posted by yxibow on June 30, 2009, at 3:05:20
Pristiq is effexor isn't it? Phillipa
Posted by yxibow on June 30, 2009, at 22:39:59
In reply to Re: Intrusive OCD thoughts?, posted by Phillipa on June 30, 2009, at 19:58:00
> Pristiq is effexor isn't it? Phillipa
Yes, a patent metabolite extension.
Posted by mogger on July 1, 2009, at 18:19:25
In reply to Re: Intrusive OCD thoughts? » Phillipa, posted by yxibow on June 30, 2009, at 22:39:59
BRC,
you absolutely must try 18 grams of Inositol a day as it has helped me with mine tremendously. No side effects and it is cheap. Google it for ocd and you will hopefully be encouraged to try it!
mogger
Posted by Bob12 on July 2, 2009, at 10:51:13
In reply to Re: Intrusive OCD thoughts?, posted by mogger on July 1, 2009, at 18:19:25
I tried a small dosage of inositol for one day- i think 200 mg, and it made me tired so I stopped. Does 18 grams make you tired?
Bob
> BRC,
> you absolutely must try 18 grams of Inositol a day as it has helped me with mine tremendously. No side effects and it is cheap. Google it for ocd and you will hopefully be encouraged to try it!
> mogger
Posted by mogger on July 2, 2009, at 12:05:58
In reply to Re: Intrusive OCD thoughts?, posted by Bob12 on July 2, 2009, at 10:51:13
Bob,
actually inositol gives me energy so much so that I can't take my usual afternoon nap anymore. I must add though that no med or supplement that I have ever tried is easy when starting. Inositol took a few weeks to get used to and at points was a little rough acclimating to it (irritable, tiredness) but the end result was well worth it.
Posted by Chris O on July 3, 2009, at 15:16:58
In reply to Intrusive OCD thoughts?, posted by BRC on June 28, 2009, at 11:53:08
I have a problem with scary, intrusive thoughts as a component of my anxiety disorder. I've tried high doses of: Prozac, Lexapro, Luvox, and Paxil. Of the four, Paxil has worked the best for me. It's not perfect, but definitely better. I'm on 75mg CR a day right now. Sometimes I augment it with 1-2mgs of Klonapin. That's my two cents.
Posted by zsmom on July 4, 2009, at 8:46:15
In reply to Intrusive OCD thoughts?, posted by BRC on June 28, 2009, at 11:53:08
My 17 yr old son was recently hospitalized for Psychosis NOS. His symptoms did not seem to fit totally with schizophrenia. I asked if it could be obsessive thoughts rather than hallucinations and voices. I have observed him like this for a long time and wondered about OCD thoughts, not really knowing that this diagnosis existed. The doctors did not think much of my position. On the day of discharge, they offered me that very same possible diagnosis. I was floored. They wasted almost 6 weeks without really exploring the possibility. Now he is at home suffering from OCD thoughts with only Clozaril as a medication. They offered a trial of Zofran (brand name) or Ondansetron on the day of discharge. Can anyone tell me what they think about this and the suggested medicine? Thank you.
Posted by bulldog2 on July 4, 2009, at 14:51:19
In reply to Re: Intrusive OCD thoughts?, posted by Phillipa on June 30, 2009, at 19:58:00
> Pristiq is effexor isn't it? Phillipa
Or is effexor actually Pristiq?
Posted by Phillipa on July 5, 2009, at 0:03:34
In reply to Re: Intrusive OCD thoughts?, posted by bulldog2 on July 4, 2009, at 14:51:19
Isn't pristiq supposed to be better for anxiety? Love Phillipa
Posted by yxibow on July 14, 2009, at 3:33:24
In reply to Re: Intrusive OCD thoughts?, posted by zsmom on July 4, 2009, at 8:46:15
> My 17 yr old son was recently hospitalized for Psychosis NOS. His symptoms did not seem to fit totally with schizophrenia. I asked if it could be obsessive thoughts rather than hallucinations and voices. I have observed him like this for a long time and wondered about OCD thoughts, not really knowing that this diagnosis existed. The doctors did not think much of my position. On the day of discharge, they offered me that very same possible diagnosis. I was floored. They wasted almost 6 weeks without really exploring the possibility. Now he is at home suffering from OCD thoughts with only Clozaril as a medication. They offered a trial of Zofran (brand name) or Ondansetron on the day of discharge. Can anyone tell me what they think about this and the suggested medicine? Thank you.
I'm not sure about the 5HT3 blockers (ondansetron, etc) other than the new ones are ridiculously expensive... I think various things have been tested for anxiety spectrum disorders so I can't say.
I know that almost all of the body's serotonin is in the gut and anxiety can cause all sorts of problems there similar to IBS, which is probably why ginger (a weak 5HT3 blockade) sometimes helps.
SSRIs also brush the 5HT3 transmitter so it takes time to get used to them and that's why the nausea occurs most usually.Discharged with Clozaril ??
I assume he is following the national (international) mandate on blood testing.
Psychosis NOS does not mean Schizophrenia... it means that it is a disorder in the psychosis spectrum which does not fit a set of criteria in the DSM-IV-TR.I have two NOS disorders, one psychosis, but it is a rare situation... it would take pages to explain... but its not something one would think of a "psychotic" disorder.
Psychosis / psychotic... there's a stigma to that word and misunderstanding, but someone can have psychosis and understand perfectly that they have a mental illness and be functioning.
I don't know if your finances or insurance covers it, or whether it is available from a psychologist trained in it or better, a hospital/teaching hospital trained to do it, but getting psychological testing....
...(yes, it includes the common things like the MMPI-II and Rorschach, but there are other subjective and objective tests and they can provide valuable insight into what is actually going on.)
It is possible for someone to have schizophrenia (or schizo-affective disorder) comorbid with OCD.
Was there a specific episode (you don't have to share if you don't wish) that made you feel hospitalization was needed?
I think better testing, such as good psychological testing and further evaluation is really necessary... I understand your frustration about this.
If Clozaril is the only atypical your son has tried, I think that's going to the "big guns" a bit too soon... but I can't practice medicine without a license so to say.A trial of any of the other ones, such as ones with lesser (not weight gain we're talking about) side and long term effects such as Seroquel or Zyprexa, would seem to be more prudent, but maybe he already tried those?
Anyhow just some suggestions
-- tidings
Posted by Brainbeard on July 14, 2009, at 14:56:07
In reply to Re: Intrusive OCD thoughts? » bleauberry, posted by yxibow on June 30, 2009, at 3:05:20
> ....well that would be Anafranil too. I can't go over 75 as the NE appears to be too much for me these days unlike in the past.
There is a way to benefit from clomipramine's (Anafranil's) SRI without most of the NRI: combine it, low dose (10-30mg), with Luvox. Luvox inhibits clomipramine's metabolism in such a way that the mother drug is boosted about tenfold while its noradrenergic metabolite only reaches subclinical levels. (Research abstracts available at request.) I've tried this combination myself, and it was pretty good for intrusive thoughts. Not many days after my daughter was born, for example, I held her in my hands while she was crying and had this intrusion: I might as well fling her through the room. I just let that thought pass by, thinking: Oh, that's just an intrusion. That was really the med combo helping me out. Luvox alone never really helped much with anxiety or intrusions. Plus, on Luvox alone I was apathetic, whereas with clomipramine (just 10mg) I would regain my initiative. Not that I want to talk you into anything.
Posted by Brainbeard on July 14, 2009, at 15:17:13
In reply to Re: Intrusive OCD thoughts?, posted by zsmom on July 4, 2009, at 8:46:15
> They offered a trial of Zofran (brand name) or Ondansetron on the day of discharge. Can anyone tell me what they think about this and the suggested medicine? Thank you.
Ondansetron has been investigated for both schizophrenia and OCD, and besides, for anxiety, panic attacks and alcohol addiction (as an aid in withdrawing). It was effective for schizophrenia, OCD and alcohol addiction. Lower doses seem to work better for OCD, in the range of 0.5-2mg two or three times a day.
The reason that ondansetron works for these indications is probably its indirect anti-dopaminergic effect. 5HT3-receptors normally regulate the release of dopamine; when inhibited, a brake is put on any dopamine around.
The brand Zofran is ridiculously expensive. Generic ondansetron can be bought for only a fraction of the brand's price overseas.
Ondansetron's very short half-life, merely three hours, may prevent it from being a steady agent. My personal experience is that I got a dopaminergic rebound some three hours after I took a dose.
Ondansetron may be worth trying. Keep in mind that ondansetron can lengthen the QT-interval (it does so at least at doses from 4mg when given intravenously) which may pose extra cardiac risk.
References at request.. ;)
I do not understand, by the way, why your son would still be on clozapine (Clorazil) when he's obsessive-compulsive rather than psychotic. Or did I get that wrong?
Posted by yxibow on July 17, 2009, at 1:52:52
In reply to Re: Intrusive OCD thoughts?, posted by Brainbeard on July 14, 2009, at 14:56:07
> > ....well that would be Anafranil too. I can't go over 75 as the NE appears to be too much for me these days unlike in the past.
> There is a way to benefit from clomipramine's (Anafranil's) SRI without most of the NRI: combine it, low dose (10-30mg), with Luvox. Luvox inhibits clomipramine's metabolism in such a way that the mother drug is boosted about tenfold while its noradrenergic metabolite only reaches subclinical levels. (Research abstracts available at request.) I've tried this combination myself, and it was pretty good for intrusive thoughts.
Huh.... 1A2 / 2D6 (p450) I think I'm guessing...
Not many days after my daughter was born, for example, I held her in my hands while she was crying and had this intrusion: I might as well fling her through the room. I just let that thought pass by, thinking: Oh, that's just an intrusion.
That does sound more like the clinical term of "pure O"... a single thought.... I tend to have a lot of varying thoughts when I get anxious, OCD just goes rambling unless I keep busy
That was really the med combo helping me out. Luvox alone never really helped much with anxiety or intrusions. Plus, on Luvox alone I was apathetic, whereas with clomipramine (just 10mg) I would regain my initiative. Not that I want to talk you into anything.
No... I've been through a lot of things.... Anafranil is doing something for my OCD perhaps a little more than Luvox but like I said, the NE makes me more nervous now. Your biochemical imbalance never is a constant thing....I was on high dose Luvox before... quite high... it is true that it actually is good for OCD, it wasn't 100% a marketing strategy.
-- Jay
Posted by Brainbeard on July 17, 2009, at 5:02:46
In reply to Re: Intrusive OCD thoughts? » Brainbeard, posted by yxibow on July 17, 2009, at 1:52:52
> Huh.... 1A2 / 2D6 (p450) I think I'm guessing...Luvox very strongly inhibits 1A2, which is why it boosts caffein so badly. It hardly touches 2D6. It also very strongly inhibits 2C19; strongly inhibits 2C9; and is a moderate inhibitor of 3A3/4. 2C19 is very important for clomipramine's metabolism; 1A2 and 3A4 are important too, and 2D6 plays a minor role.
> No... I've been through a lot of things.... Anafranil is doing something for my OCD perhaps a little more than Luvox but like I said, the NE makes me more nervous now. Your biochemical imbalance never is a constant thing....
'With gradually increasing dosing of clomipramine the plasma concentrations of desmethylclomipramine (noradrenergic action) is 40-85% higher than the concentration of clomipramine at a dose level of 75 mg/day' (Eriksson E. Strong but non-selecitve serotonin re-uptake inhibition: the unique profile of clomipramine. Anafranil (clomipramine); Past, present and future, a product profile. Basel: Ciba-Geigy 1994; 86-93).
> I was on high dose Luvox before... quite high... it is true that it actually is good for OCD, it wasn't 100% a marketing strategy.Agreed, though it should have been marketed as an antidepressant as well. Luvox' specificity for OCD may be due to its action on sigma-1 receptors, or its potent (and literally nauseating) stimulation of 5HT3-receptors, which eventually leads to desensitation of these receptors which will result in 'defacilitation' of dopamine. Just like ondansetron does with its direct 5HT3-antagonism.
Posted by Phillipa on July 17, 2009, at 20:29:57
In reply to Re: Intrusive OCD thoughts? » Brainbeard, posted by yxibow on July 17, 2009, at 1:52:52
Daughter???? Phillipa
Posted by yxibow on July 18, 2009, at 0:36:01
In reply to Re: Intrusive OCD thoughts? » yxibow, posted by Phillipa on July 17, 2009, at 20:29:57
> Daughter???? Phillipa
It was a response to the previous post, Jan...
I don't have children! Though I've wanted in the past...
- Jay
Posted by SLS on July 18, 2009, at 1:44:10
In reply to Re: Intrusive OCD thoughts?, posted by Brainbeard on July 14, 2009, at 15:17:13
Hi Brainbeard.
Which dopaminergic brain regions or tracts does 5-HT3 receptor stimulation activate?
How might memantine work as a treatment for OCD?
Thanks.
- Scott
Posted by Brainbeard on July 18, 2009, at 7:55:45
In reply to Re: Intrusive OCD thoughts? » Brainbeard, posted by SLS on July 18, 2009, at 1:44:10
> Hi Brainbeard.
>
> Which dopaminergic brain regions or tracts does 5-HT3 receptor stimulation activate?
>
> How might memantine work as a treatment for OCD?
>
> Thanks.
>
>
> - ScottOMG.. An assignment! Gimme some time, Scott... Just gimme some time..
I think it was the mesolimbic region............
'In this brief review, we present the evidence for the regulation of the mesolimbic dopamine system by 5-HT3 and 5-HT4 receptors. A range of studies show good evidence that 5-HT3 receptor antagonists reduce raised mesolimbic dopamine activity by blocking 5-HT3 receptors in terminal parts of the mesolimbic dopamine system.'(Behavioural Brain Research
Volume 73, Issues 1-2, 15 December 1995, Pages 11-13)To be honest, I know almost nothing about the different brain regions and their functions. I think that the mesolimbic region is linked to emotions, amongst other things. Anyone feel free to enlighten me.
[Does some quick googling] No, it is a MEDIATOR between the limbic (emotional) system and other parts of the brain.
Wikipedia: 'It [the mesolimbic pathway] is known to be involved in modulating behavioral responses to stimuli that activate feelings of reward (motivation) and reinforcement through the neurotransmitter dopamine'.Memantine.. Almost never heard of it.. I saw someone using it a while ago on this forum.. [Does some quick googling] Memantine, my friend, is an N-methyl-D-aspartic acid glutamatergic receptor antagonist. That's right. So, how can it help with OCD? Well, I would say by attenuating glutamatergic hyperactivity (http://ajp.psychiatryonline.org/cgi/content/full/162/11/2191-a).
Posted by SLS on July 18, 2009, at 9:31:18
In reply to Re: Intrusive OCD thoughts?, posted by Brainbeard on July 18, 2009, at 7:55:45
> Memantine.. Almost never heard of it.. I saw someone using it a while ago on this forum.. [Does some quick googling] Memantine, my friend, is an N-methyl-D-aspartic acid glutamatergic receptor antagonist. That's right. So, how can it help with OCD? Well, I would say by attenuating glutamatergic hyperactivity (http://ajp.psychiatryonline.org/cgi/content/full/162/11/2191-a).
From what I remember reading, OCD might involve pathological glutamatergic pathway looping. Perhaps this perpetual looping is the result of insufficient "braking" of these pathways by serotonergic modulation, probably afferent from the Raphe Nuclei. That's my guess, anyway.I hope you stick around. I find your input to be very valuable.
- Scott
Posted by Brainbeard on July 18, 2009, at 16:03:15
In reply to Re: Intrusive OCD thoughts? » Brainbeard, posted by SLS on July 18, 2009, at 9:31:18
> I hope you stick around. I find your input to be very valuable.
>
>
> - Scott
>
That's very nice of you to say, Scott. You know how it is: people come and people go. I tried emailing AndrewB a while ago, who has made many fantastic contributions to this forum. I had a question about amisulpride and pramipexole. Never got a reply.
Posted by zsmom on July 18, 2009, at 17:00:10
In reply to Re: Intrusive OCD thoughts?, posted by Brainbeard on July 14, 2009, at 15:17:13
No, you did not get it wrong. When my son was discharged, that was their great revelation after being treated with Clozaril in the hospital. I asked them if it was possible that he was not really hearing or seeing things, but having obsessive thoughts. On discharge, that is when they gave it some weight and considered it, but now he is at home. Seems to be doing fairly well. No more talking to people I don't see or responding to internal stimuli. No more shadow boxing. His performance in school declined greatly since Sept 2008. All of those reasons are what led to hospitalization. Punching in his bedroom window did not help either. Psychiatrist reduced the clozaril by 50 mg per day since discharge. Now he only takes 150 mg per day. We are still working on trying to find out the correct diagnosis and medicine. Thank you for you insight. I won't give up.
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