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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 uncouth on September 2, 2009, at 5:54:31
It's 3.52am and i'm awake, tormented by ruminations and obsessions over past regrets and a girl. At this point it will almost be 2 years since we had a 'thing', which is extremely distressing to me. The thoughts never stop, even when I'm doing something else, they are in the bkgd.
It's hell and I need some relief. Luvox didn't help, clomipramine, i couldn't tolerate. What other meds are good for obsessions and ruminations? I suppose my high dose bupropion probably doesn't help, but I need some relief
Posted by Phillipa on September 2, 2009, at 11:06:30
In reply to Rumination and obsessions, posted by uncouth on September 2, 2009, at 5:54:31
Uncouth I do the same thing only different ruminations and sleep now instead of remanin awake. I still take low dose luvox. Each morning I wake with a horrible scarey thought for the day about my health. I know the feeling well. Phillipa
Posted by Ron Hill on September 2, 2009, at 13:19:02
In reply to Rumination and obsessions, posted by uncouth on September 2, 2009, at 5:54:31
> It's 3.52am and i'm awake, tormented by ruminations and obsessions over past regrets and a girl. At this point it will almost be 2 years since we had a 'thing', which is extremely distressing to me. The thoughts never stop, even when I'm doing something else, they are in the bkgd.
>
> It's hell and I need some relief. Luvox didn't help, clomipramine, i couldn't tolerate. What other meds are good for obsessions and ruminations? I suppose my high dose bupropion probably doesn't help, but I need some relief
Hi Couth,Consider a moodstabilizer. I like Trileptal (an AED) to treat hypomania which can include ruminations. Another approach is an antipsychotic medication. The latter are laced with side effects, but they are heavy hitters if needed.
-- Ron
dx: Bipolar II and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil
Posted by doxogenic boy on September 2, 2009, at 15:47:45
In reply to Rumination and obsessions, posted by uncouth on September 2, 2009, at 5:54:31
> It's 3.52am and i'm awake, tormented by ruminations and obsessions over past regrets and a girl. At this point it will almost be 2 years since we had a 'thing', which is extremely distressing to me. The thoughts never stop, even when I'm doing something else, they are in the bkgd.
---------------Seroquel has helped me against racing thoughts and insomnia. If the obsessions are part of a obsessive-compulsive disorder, you may add Lexapro.
doxogenic
Posted by uncouth on September 2, 2009, at 16:38:33
In reply to Re: Rumination and obsessions » uncouth, posted by doxogenic boy on September 2, 2009, at 15:47:45
is lexapro better than zoloft or effexor for racing obsessive thoughts?
Posted by Sunbath on September 3, 2009, at 4:13:44
In reply to Re: Rumination and obsessions, posted by uncouth on September 2, 2009, at 16:38:33
Hi uncouth!
I'm very sorry that this is happening to you.. I was also suffering from exzessive ruminating over things that obviously I shouldn't worry about anymore.. this was going on for at least 3 years.. finally after trying many meds paxil helped me when zoloft didn't.. maybe because paxil is the strongest 5ht reuptake inhibitor (at least regarding its affinity for the 5HTT).
I wish you all the best and good luck with whatever med you try next!
Posted by doxogenic boy on September 3, 2009, at 14:56:30
In reply to Re: Rumination and obsessions, posted by uncouth on September 2, 2009, at 16:38:33
> is lexapro better than zoloft or effexor for racing obsessive thoughts?
-------------My psychiatrist has said that Lexapro (escitalopram) probably is more effective against OCD, because of its mode of action. He also say that Seroquel makes the patient tolerate higher doses of Lexapro.
In my experience, racing (obsessive) thoughts need an neuroleptic, such as Seroquel, just a SSRI isn't enough.
This is what I use:
1) quetiapine (Seroquel) 600 mg
2) liothyronine sodium (L-isomer of triiodothyronine (T3); Cytomel, Liothyronin)
20 µg (microgram)
3) escitalopram (Cipralex/Lexapro) 40 mg
4) tianeptine (Stablon) 150 mg
5) clonazepam (Klonopin, Rivotril) 1 mg
6) trimipramine (Surmontil) 100 mg
7) pramipexole (Sifrol/Mirapex) 0.264 mg
(0.088 mg X 3)+++++++++++++++++++++++++++++++
http://www.ncbi.nlm.nih.gov/pubmed/19238126CNS Spectr. 2009 Feb;14(2 Suppl 3):13-23.
LinksNew pharmacotherapeutic approaches to obsessive-compulsive disorder.
Figee M, Denys D.
[...cut...]
Results show that recent developments in the treatment of OCD have been modest and primarily involve evidence for the efficacy of escitalopram and other selective serotonin reuptake inhibitors (SSRIs); augmentation with antipsychotics in treatment-refractory patients and combination treatment with D-cycloserine and cognitive-behavioral therapy has also been effective. The efficacy of serotonin-norepinephrine reuptake inhibitors remains inconclusive.
[...cut...]
++++++++++++++++++++http://www.ncbi.nlm.nih.gov/pubmed/19497245
J Clin Psychiatry. 2009 Jul;70(7):1001-8. Epub 2009 Jun 2.Click here to read Links
Quetiapine augments the effect of citalopram in non-refractory obsessive-compulsive disorder: a randomized, double-blind, placebo-controlled study of 76 patients.
[...cut...]
CONCLUSIONS: The combination of quetiapine and citalopram was more effective than citalopram alone in reducing OCD symptoms in treatment-naive or medication-free OCD patients.++++++++++++++++++++
http://www.ncbi.nlm.nih.gov/pubmed/11543737
Quote from the link:
Biol Psychiatry. 2001 Sep 1;50(5):345-50.Click here to read Links
Second-generation SSRIs: human monoamine transporter binding profile of escitalopram and R-fluoxetine.
Owens MJ, Knight DL, Nemeroff CB.[...cut...]
RESULTS: Both escitalopram and R-fluoxetine were potent inhibitors of the serotonin transporter (K(i) = 1.1 and 1.4 nmol/L, respectively). Escitalopram was the most serotonin transporter-selective compound tested and was approximately 30-fold more potent than R-citalopram. CONCLUSIONS: As noted previously, paroxetine and sertraline possess moderate affinity (<50 nmol/L) for the human norepinephrine transporter and dopamine transporter, respectively. R-Fluoxetine, unlike the other selective serotonin reuptake inhibitors, possesses moderate affinity (K(i) = 64 nmol/L) for the serotonin 2C receptor. Potential clinical correlates of these unique attributes of escitalopram and R-fluoxetine are discussed.
++++++++++++
+++++++++++http://www.ncbi.nlm.nih.gov/pubmed/16953656
1: CNS Drugs. 2006;20(9):763-90.Links
Escitalopram: a review of its use in the management of anxiety disorders.
[...cut...]
Escitalopram (Cipralex, Lexapro, Seroplex, Sipralexa), the therapeutically active S-enantiomer of racemic citalopram (RS-citalopram), is a potent and highly selective serotonin reuptake inhibitor. It is effective and generally well tolerated in the treatment of moderate to severe generalised anxiety disorder (GAD) or social anxiety disorder (SAD), panic disorder (with or without agoraphobia) as well as obsessive-compulsive disorder (OCD). Moreover, escitalopram is at least as effective as paroxetine for the treatment of GAD, SAD or OCD and appears to achieve a more rapid response than racemic citalopram in the management of panic disorder. Generally, it has a more favourable tolerability profile than paroxetine in terms of fewer discontinuation symptoms. In addition, a favourable pharmacokinetic profile permits once-daily administration of the drug. Additional comparative studies are required to definitively position escitalopram with respect to other SSRIs and venlafaxine. Nevertheless, available clinical data indicate that escitalopram is an effective first-line treatment option for the management of GAD, SAD, panic disorder and OCD.
+++++++++++++++++++
+++++++++++++++++++
Please tell me if there are any mistakes in my postsdoxogenic
Posted by obsidian on September 4, 2009, at 20:43:07
In reply to Rumination and obsessions, posted by uncouth on September 2, 2009, at 5:54:31
some of this sounds like my version of intrusive thoughts....the thing that i really don't want to think about is the thing that pops into my head.
I guess it's all under the umbrella of ruminations though....
always some interaction that didn't feel good going over and over and over in my mind
seroquel has helped me at 50mgs, and I often think it works because I am simply asleep and sedated enough not to get stuck in it again, it just kind of quiets my mind down...but I hate it.
Posted by Garnet71 on September 5, 2009, at 18:46:23
In reply to Rumination and obsessions, posted by uncouth on September 2, 2009, at 5:54:31
That sounds awful, Uncouth. Take a look at this book - page 198 - and see if you can recognize a pattern (the topic is eating disorder - but the chart maps out the potential source of this type of thinking):
Lately I've found Google books to be really helpful, though some pages are omitted from most. Here's a whole book on OCD for ya-hope it helps. I hope you get better soon :)
Posted by Garnet71 on September 5, 2009, at 20:51:43
In reply to Rumination and obsessions, posted by uncouth on September 2, 2009, at 5:54:31
Maybe learning about why you have such thoughts in the first place may be helpful until you find a med that works.
http://www.ehow.com/how_2054274_deal-unrequited-love.html
Here is a short summary:
http://www.nvo.com/psych_help/obsessivelovedisorder/
(ignore the word disorder-i just thought a short article that provided a concrete example may be helpful)
Meds to help? I really wish I had an answer for you. Clomapramine or SSRIs is what's indicated in the psychiatric manuals I scanned through-seratonin blamed to be the culprit in many cases. Oh, you can't do clomapramine.. Norepinephrine acting meds added for those with comorbid depression and dopamine meds can worsen the condition - like wellbutrin.
Posted by ace on September 6, 2009, at 23:51:39
In reply to Rumination and obsessions, posted by uncouth on September 2, 2009, at 5:54:31
> It's 3.52am and i'm awake, tormented by ruminations and obsessions over past regrets and a girl.
Ruminations over girls? I can empathise!
First it sounds as if this must be differntiated fro 'normal' worry and placed in the pigeon hole of 'psychopathology'. As such, this will let you not 'buy' into the thoughts as much....At this point it will almost be 2 years since we had a 'thing', which is extremely distressing to me. The thoughts never stop, even when I'm doing something else, they are in the bkgd.
This might sound strange in light of the previous comment, but I would acvtively pursue other woman and try and fantasize about others- try even if it doesn't seem to work...
>
> It's hell and I need some relief. Luvox didn't help, clomipramine, i couldn't tolerate. What other meds are good for obsessions and ruminations? I suppose my high dose bupropion probably doesn't help, but I need some reliefRisperidone, Seroquel, Abilify- all very low dose...
Try Anafranil again- but titrate very very slow...
Clonazepam, MAOI's, Clonidine, low dose Tegretolhang in their!
Ace:)
This is the end of the thread.
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