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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 rianny on January 23, 2004, at 16:56:13
Is there any drug for OCD other than SSRI?
I'm currently on very low dosage of Clonazepam for anxiety, and I have OCD, too.I have tried three SSRI's so far: Paxil, Celexa, and Luvox. The first two ended up with no result. Celexa actually made me worse. With Luvox, I haven't gone too far with it. I was on very low dosage of Luvox, and just quit it.
So, I wonder if there is any drug out there that works for OCD patients, other than SSRI...and possibly MAOI. MAOI is something that I would try for last because I'll have to change whole course of meals.
Thank you for reading.
Posted by krybrahaha on January 24, 2004, at 2:47:07
In reply to any other OCD drug other than SSRI?, posted by rianny on January 23, 2004, at 16:56:13
as far as i know, the only other med used for OCD other than the SSRI's is called Anafranil (clomipramine). Its called an tricyclic. Its an old school antidepressant and has been around for years. However, it does have bad side effects so thats why people like the ssri's for their ocd than anafranil. Did you ever think of giving Luvox a longer trial period. I have bad OCD and Anxiety myself and it took up to 12 weeks before i noticed any difference. It takes longer to work with antidepressants for OCD. I take 300 mgs.
Posted by rianny on January 24, 2004, at 3:06:05
In reply to Re: any other OCD drug other than SSRI?, posted by krybrahaha on January 24, 2004, at 2:47:07
Thank you for your suggestion.
I'm a little afraid to try another SSRI because I had real bad experience with Celexa. Maybe that drug was not for me. I felt like I do not exist while taking that drug. My cognitive skill was comepletely impaired, too.
Posted by Ame Sans Vie on January 24, 2004, at 8:04:30
In reply to Re: any other OCD drug other than SSRI?, posted by rianny on January 24, 2004, at 3:06:05
Narcotic painkillers have been shown time and time again to work miracles for OCD'ers. Even when SSRIs or Anafranil are effective in treating OCD, chances are that an opioid drug could further ameliorate symptoms to the point of complete remission. Not to mention the nice antidepressant effect provided by this class of drugs.
While morphine, hydrocodone, oxycodone, hydromorphone, codeine, methadone, propoxyphene, levomethorphan, fentanyl, oxymorphone, dihydrocodeine, meperidine et al have all been shown, in varying degrees, to be quite efficacious in treating OCD (i.e. achieving symptom remission with the very first dose), the problem with these drugs is primarily one of opiophobia on the part of the prescriber -- it takes an M.D. with an open mind to consider such unorthodox approaches to treatment.
But then along came Ultram. :-) It's not currently a federally controlled substance (which means a doctor is much more likely to feel comfortable in prescribing it off-label for a mental disorder), it is (based on my subjective experience) about as potent milligram for milligram as codeine regarding its euphoriant/analgesic/anxiolytic effects, tolerance isn't nearly as common with Ultram as it is with other opioids (and a simple OTC cough suppressant and/or DL-phenylalanine can be taken to prevent tolerance completely in many cases), and the icing on the cake -- Ultram inhibits the reuptake of both serotonin and norepinephrine. Effexor achieves the same thing in the brain and it is now speculated that Ultram is more an "antidepressant in disguise" than anything else (though it is a great painkiller). Not only do Effexor and Ultram share these reuptake inhibition properties, but both activate opiate receptors (Ultram more so than Effexor, though).
If you'd like any additional information, just ask. E-mail me at amesansvie@yahoo.com if you'd like and I can supply you with a ton of clinical information on Ultram's antidepressant/antiobsessive qualities that you could present to your physician.
Posted by KathrynLex on January 24, 2004, at 11:55:01
In reply to Re: any other OCD drug other than SSRI?, posted by rianny on January 24, 2004, at 3:06:05
Hi Riannny,
I don't have much experience with OCD, but I wanted to write and encourage you not to give up on SSRI's yet. I had a horrible experience when I tried Paxil for anxiety/depression. It gave me three nights of the worst panic attacks I've had in my entire life. After being on it for only 3 days I tossed the bottle in the trash. My doc started me at 20 mg, prescribed it over the phone without even seeing me! I've learned that I'm med sensitive and should have started at 5 or 10 mg, then slowly increased to 20 mg.
When I found a new doc, he prescribed lexapro. I was terrified that I would have another bad reaction to an SSRI. I sat with the pill in my hand for 20 minutes before taking it. The side effects were a little scary for the first 3 or 4 weeks, but they were tolerable. I'm heading in to week six on lex and my anxiety/depression has diminished quite a bit and I'm beginning to feel like my old self again.
I am so grateful that I gave SSRI's another chance, because they've done wonders for me. Please discuss your bad experience on Celexa with your doc. He/She might be able to figure out what caused the bad reaction, and can prescribe you a milder SSRI that will give you results.
Either way, I wish you the very best of luck in treating your OCD.
K.
> Thank you for your suggestion.
> I'm a little afraid to try another SSRI because I had real bad experience with Celexa. Maybe that drug was not for me. I felt like I do not exist while taking that drug. My cognitive skill was comepletely impaired, too.
Posted by SDA on January 26, 2004, at 1:04:35
In reply to any other OCD drug other than SSRI?, posted by rianny on January 23, 2004, at 16:56:13
I was put on Zoloft for OCD when I was in my early teens. I think it helped somewhat. After a few years it just stopped working though. I never had any really bad side effects while on it. Of course I can't comment on the sexual side effects since I was well under the legal age (and flamboyantly nerdy). I stopped taking it a couple years ago, and don't remember any withdrawal side effects. Now I'm in the midst of an episode of depression (I think), so I may need to start up again.
Posted by Chairman_MAO on January 26, 2004, at 16:55:24
In reply to Re: any other OCD drug other than SSRI? » rianny, posted by Ame Sans Vie on January 24, 2004, at 8:04:30
>
> But then along came Ultram. :-) It's not currently a federally controlled substance (which means a doctor is much more likely to feel comfortable in prescribing it off-label for a mental disorder), it is (based on my subjective experience) about as potent milligram for milligram as codeine regarding its euphoriant/analgesic/anxiolytic effects, tolerance isn't nearly as common with Ultram as it is with other opioids (and a simple OTC cough suppressant and/or DL-phenylalanine can be taken to prevent tolerance completely in many cases), and the icing on the cake -- Ultram inhibits the reuptake of both serotonin and norepinephrine. Effexor achieves the same thing in the brain and it is now speculated that Ultram is more an "antidepressant in disguise" than anything else (though it is a great painkiller). Not only do Effexor and Ultram share these reuptake inhibition properties, but both activate opiate receptors (Ultram more so than Effexor, though).
>
>Ultram is basically a "pro-drug" whose active metabolite is an opioid. Its maker likes to emphasize its "reuptake-blocking" properties in purporting a "dual" mechanism of action. This is "data-spinning" on a grand scale. Facts the manufacturer seems not to consider:
* Many other opiate/opioid drugs (methadone comes immediately to mind) block monoamine reuptake to varying degrees,
* AND ultram blocks monoamine reuptake with approx. 1/50th the potency of imipramine. The usual dose range of imipramine is 50-150mg; I strongly suspect the analgesia you'd experience with 1-3mg of imipramine would not be as profound as that induced by the water used to take the dose.Call me a simpleton, perhaps, but I don't see how tramadol is anything significant besides a weak mu agonist with a delayed onset of activity. Absurd DEA classifications aside, I doubt one could discriminate between a pinch of morphine and a "regular" dose of tramadol (aside from the morphine not having that extra seizure risk, etc.)
Insofar as its an "antidepressant in disguise", ALL opioids are antidepressants in disguise (you no doubt realize this :) ). Arguably, they are among the PROTOTYPICAL antidepressants. Was it Aristotle who said that there is no real distinction between physical and psychic pain? That the opioids act more or less indiscriminately on both seems to bear this assertion out.
Finally, it is worthy of mention that amphetamine (and other dopamine agonists such as bromocriptine and pramipexole) often work in "treatment-refractory" OCD (and depression).
Occam's razor (philosophy's 'K.I.S.S.'): Perhaps psychic distress simply responds well to a nice healthy buzz ...
Posted by Maxime on January 27, 2004, at 10:40:05
In reply to Re: any other OCD drug other than SSRI?, posted by rianny on January 24, 2004, at 3:06:05
As someone posted anafranil is a good choice. I have a friend who is taking it for that purpose. She also finds that Zyprexa works very well as well.
I know Ace had OCD and has tried many things. Maybe you should ask him.
I hope you feel better soon.
Maxime
Posted by Francesco on January 27, 2004, at 15:32:58
In reply to any other OCD drug other than SSRI?, posted by rianny on January 23, 2004, at 16:56:13
You may want to check this out ...
http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.html
As you can see from the list there other meds other than SSRIs for OCD. I have been on Anafranil for other problems (ADHD) ... I have been on it for years therefore I can't say the side-effects were unbearable in the long-term.
I don't know nothing about opioid treatment for OCD ... I'm sure they work but I think it's not the first thing that comes to your doctor's mind when you talk him about OCD ;-) According to the link Nardil can be useful for OCD ... I'm on Parnate (MAOI) right now and I have understood that dietary restrictions are not a big deal ...
Good Luck
Posted by terrics on January 27, 2004, at 16:32:32
In reply to any other OCD drug other than SSRI?, posted by rianny on January 23, 2004, at 16:56:13
Hi, I was on zoloft for depression for many years. When I first started taking it I noticed that the few compulsive habits I had were gone...that was before it was used for ocd. It had few side effects for me. theresa
Posted by Tiss on January 27, 2004, at 18:52:53
In reply to Re: any other OCD drug other than SSRI?, posted by terrics on January 27, 2004, at 16:32:32
My daugher is 16 and was diagnosed with OCD when she was in 5th grade. I hate this disorder and would do anything to take it away from her. She was on luvox 1st and stayed on it for years.It was sedating so the dr put her on 80mg of prozac. Oh my God, this was like watching your child turn into a zombie-it was horrible to see and I made them take her off of it. She is on lexapro now with no side effects, except maybe a little drowsiness. She said it helps as much as the others did with the OCD. She's had a moderate response to meds with the OCD. I would like to see new meds specifically targeting OCD. I've never heard of using opiates or narcotics for OCD and I don't think I'd want to see a 16 year on that kind of drug but who knows maybe those will be the miracle drug for OCD. My heart goes out to you all dealing with this. Tiss
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