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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Phidippus on January 21, 2011, at 19:02:09
I have tried Keppra, Lyrica, Memantine, Odansetron, Tramadol, Gabitril, Topemax, Dextroamphetamine, Seroquel, Zyprexa, Geodon, Abilify and Invega. The ones that have worked best are Vyvanse, Invega, Lyrica, Keppra and Tramadol. Right now I am on:
Lithium 1200 mg
Clomipramine 200 mg
Invega 9 mg
Vyvanse 50 mg
Lyrica 300 mg
Ativan 2mgI might as well be 'cured' of OCD except I still struggle with suicidal ideations. Intrusive suicidal urges ping me throughout the day.
Posted by mrtook on January 21, 2011, at 23:20:14
In reply to Best augmentation Strategy for treating OCD?, posted by Phidippus on January 21, 2011, at 19:02:09
I don't have any great ideas, but some questions
1.) When you mean suicidal ideation do you mean you have a wish to no longer live, or it is an unwelcome violent thought? Sorry if this is obvious, I have just always been confused by that term.
2.) You haven't tried any of the SSRI's? I realize clomipramine has a similar method of action just curious why you went straight to this.
3.) Deplin might be good? If you have the particular genetic defect that Deplin is designed to overcome, it can be a very effective med even though it is really just a prescription vitamin.
4.) As far as supplements go I know people are having luck with inositol and NAC...
5.) Would you be willing to go the MAOI route? I have read before that can be effective for treatment refractory OCD.
Sorry I don't have more.
Posted by Phillipa on January 22, 2011, at 0:09:30
In reply to Best augmentation Strategy for treating OCD?, posted by Phidippus on January 21, 2011, at 19:02:09
Do you mean Obsessive compulisive urges gone. Were they rituals or the keep doing things over and over again like hand washing? If that is gone are you saying you have suicidal urges? Would you act on them or just think of them. Sounds like calling your doc or crisis line would help. With OCD you might act impulsivly? Phillipa
Posted by floatingbridge on January 22, 2011, at 17:03:24
In reply to Best augmentation Strategy for treating OCD?, posted by Phidippus on January 21, 2011, at 19:02:09
Hi Phidippus,
So you've seen some improvement? Is it the content of the intrusions that are most distressing? (Like the other posters, I'm concerned about suicidal feelings--you used the word 'urges'.)
Are you working with a therapist currently? If they are 'only' intrusive thoughts, maybe the contents could be shifted, though you are probably adept at that. Are you also depressed?
I'm concerned.
fb
Posted by Phidippus on January 23, 2011, at 19:19:00
In reply to Re: Best augmentation Strategy for treating OCD? » Phidippus, posted by floatingbridge on January 22, 2011, at 17:03:24
> So you've seen some improvement? Is it the content of the intrusions that are most distressing?
Basically, I'll be doing my daily business and then all of a sudden this feeling/urge will hit me and then I will have suicidal thought or an argument with myself over being suicidal.
I have no long lasting suicidal feelings. I love life and would love to keep living it without constantly having to fight intrusive suicidal ideations
You said contents 'shifted'. How do you mean?
I get depressed when I have these out of control suicidal ideations. I almost become convinced I really am suicidal.
P
Posted by floatingbridge on January 23, 2011, at 23:18:30
In reply to Re: Best augmentation Strategy for treating OCD? » floatingbridge, posted by Phidippus on January 23, 2011, at 19:19:00
Phidippus
What I meant was, if you can't prevent the intrusion, can you change or 'shift' the contents to be less alarming or distressing? Over time, maybe, and w/ or w/o a therapist.
I'm sorry you are going through this.
So no depression or signs that the OCD is wearing you down?
fb
This is a random thought that occurred: rTMS for OCD? (Best wishes to you.)
Posted by Phidippus on January 24, 2011, at 16:49:22
In reply to Re: Best augmentation Strategy for treating OCD? » Phidippus, posted by floatingbridge on January 23, 2011, at 23:18:30
I try my best to exaggerate the content of the thought until it is farcical. Either that or I pretend to kill myself in a loud and silly manner.
None of my ERP work has diminished the thought. Maybe I am slightly suicidal.
P
Posted by floatingbridge on January 24, 2011, at 17:10:13
In reply to Re: Best augmentation Strategy for treating OCD? » floatingbridge, posted by Phidippus on January 24, 2011, at 16:49:22
P,
I imagine your condition does create stress and perhaps some major inconvenience and compromise. I also imagine that stress can be demoralizing and frustrating. Do you have a therapist besides a specialty treatment one? Just a thought.
(I don't know ERP....)
best to you,
fb
Posted by mrtook on January 24, 2011, at 17:40:05
In reply to Re: Best augmentation Strategy for treating OCD? » floatingbridge, posted by Phidippus on January 24, 2011, at 16:49:22
P,
Does your ERP work produce anxiety when done? If not it might be the most correctly designed for what you are obsessing on.
For others ERP is Exposure Response and Prevention, the basic idea is to, in a controlled fashion, expose yourself to your obsession, and try to prevent your standard response while experiencing the anxiety. It is best done with the help of a therapist.
Posted by Phidippus on January 25, 2011, at 17:39:24
In reply to Re: Best augmentation Strategy for treating OCD?, posted by mrtook on January 24, 2011, at 17:40:05
I do ERP for the intrusive suicidal ideations. It doesn't seem to diminish them. The addition of new drugs, however has proved successful in lessening the ideations.
P
Posted by floatingbridge on January 29, 2011, at 23:06:39
In reply to Re: Best augmentation Strategy for treating OCD? » mrtook, posted by Phidippus on January 25, 2011, at 17:39:24
P, are you familiar with DBT? One thing taught is distress tolerance skills. Just a thought.
Be well.
fb
Posted by Phidippus on January 30, 2011, at 21:02:39
In reply to Re: Best augmentation Strategy for treating OCD? » Phidippus, posted by floatingbridge on January 29, 2011, at 23:06:39
Distress Tolerance! One of my favorites. Yes, there's much distress I tolerate. Just switched to Abilify...We'll see what happens.
P
Posted by floatingbridge on January 30, 2011, at 22:23:35
In reply to Re: Best augmentation Strategy for treating OCD? » floatingbridge, posted by Phidippus on January 30, 2011, at 21:02:39
I'm sorry you're having such a go of it Phidippus. Best of luck with Abilify.
fb
Posted by Chairman_MAO on February 2, 2011, at 0:19:18
In reply to Re: Best augmentation Strategy for treating OCD?, posted by mrtook on January 21, 2011, at 23:20:14
clonazepam + Adderall/Dexedrine/Desoxyn, Desoxyn is preferable, but good luck getting it.
Opioid drugs also can help with OCD. For psychiatric use, it's probably best to start with buprenorphine sublingually. Subutex or Suboxone, 0.3-4mg qid. Dosing doesn't have to be qid, but IMHO it's best that way.
Buprenex ampules may be used if you only need sub-milligram doses.
Posted by Chairman_MAO on February 2, 2011, at 0:21:22
In reply to Re: Best augmentation Strategy for treating OCD?, posted by Chairman_MAO on February 2, 2011, at 0:19:18
Needless to say, you can also add an SSRI to this regime.
Posted by Phidippus on February 2, 2011, at 12:12:27
In reply to Re: Best augmentation Strategy for treating OCD?, posted by Chairman_MAO on February 2, 2011, at 0:19:18
I take 20 mg of Oxycodone every day and it does help, but only for a short period of time. I would not like to be taking opiates day and night, however.
P
Posted by Chairman_MAO on February 2, 2011, at 16:03:35
In reply to Re: Best augmentation Strategy for treating OCD? » Chairman_MAO, posted by Phidippus on February 2, 2011, at 12:12:27
Ask about memantine or riluzole (Rilutek)?
http://ajp.psychiatryonline.org/cgi/content/full/162/11/2191-a
Posted by Phidippus on February 2, 2011, at 16:59:46
In reply to Re: Best augmentation Strategy for treating OCD?, posted by Chairman_MAO on February 2, 2011, at 16:03:35
Memantine is alright. Rilutek costs too much, as my insurance does not cover it.
This is the end of the thread.
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