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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by g_g_g_unit on November 2, 2009, at 15:12:09
i was sent this by an OCD researcher at Stanford. if anyone wants the full text, i can e-mail it to them.
"Page 1
Dextroamphetamine vs Caffeine Augmentation for OCD
Published online ahead of print: J Clin Psychiatry June 30, 2009: e1e6 (doi:10.4088/JCP.08m04605).
Available at
© Copyright 2009 Physicians Postgraduate Press, Inc.
e1
Double-Blind Study of
Dextroamphetamine Versus Caffeine Augmentation
for Treatment-Resistant Obsessive-Compulsive Disorder
Lorrin M. Koran, MD; Elias Aboujaoude, MD; and Nona N. Gamel, MSW
Introduction: Two small, double-blind,
placebo-controlled, single-dose, crossover studies
found dextroamphetamine (d-amphetamine) 30 mg
clearly superior to placebo in relieving symptoms
of obsessive-compulsive disorder (OCD). We con-
ducted a 5-week, double-blind, caffeine-controlled
study to test the hypothesis that d-amphetamine,
added after an adequate selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reup-take inhibitor (SNRI) trial, would be more effective than caffeine in reducing residual OCD symptoms of moderate or greater severity.Method: Between August 2006 and February
2008, we enrolled adults with DSM-IV OCD and a
Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
score of ≥20 after ≥12 weeks of adequate treatment
with an SSRI or SNRI. Subjects were randomly as-
signed to double-blind d-amphetamine 30 mg/d or
caffeine 300 mg/d added to their SSRI/SNRI and
other medications. Responders (first week mean
Y-BOCS score decrease of ≥20%) entered the
studys 4-week double-blind extension phase.
Results: We enrolled 24 subjects, 11 women and
13 men, with a mean (SD) age of 40 (13.2) years and mean baseline Y-BOCS scores of 26.5 (4.1) for the d-amphetamine group (n=12) and 29.1 (4.0) for the caffeine group (n=12). At the end of week 1, six of 12 d-amphetamine subjects (50%) and 7 of 12 caffeine subjects (58%) were responders. At week 5, the responders mean Y-BOCS score decreases were, for the d-amphetamine group (last observation carried forward), 48% (range, 20%80%); and, for the
caffeine group, 55% (range, 27%89%). Obsessive-
compulsive disorder and depression improvement
were independent. The double-blind remained intact. No subject discontinued the study due to side effects.Conclusions: Larger, double-blind, placebo-
controlled trials of both d-amphetamine and caffeine augmentation are needed in OCD subjects inad-equately responsive to adequate doses of an SSRI or SNRI.
Trial Registration: clinicaltrials.gov Identifier:
NCT00363298
J Clin Psychiatry
© Copyright 2009 Physicians Postgraduate Press,
Posted by Phillipa on November 2, 2009, at 15:20:59
In reply to d-amphetamine + caffeine use in OCD - study, posted by g_g_g_unit on November 2, 2009, at 15:12:09
Thanks great article. As have been using caffeine for energy. Phillipa green teas.
Posted by Phidippus on November 2, 2009, at 20:53:32
In reply to d-amphetamine + caffeine use in OCD - study, posted by g_g_g_unit on November 2, 2009, at 15:12:09
Caffeine-induced inhibition of mEPSC amplitude occurs through postsynaptic block of non-NMDA type ionotropic glutamate receptors. Caffeine thus has both pre and postsynaptic sites of action at excitatory synapses. Caffeine inhibits currents activated by direct application of glutamate to cortical neurons, confirming a postsynaptic site of action.
By blocking glutamate transmission, Caffeine and Dextroamphetamine can help control OCD symptoms. GLutamate is the key neurotransmitter implictaed in OCD and most of the drugs shown efficacious in treating OCD in some way inhibit or modulate glutamate.
Riluzole and Memantine are other NMDA antagonists which are being studied to treat OCD.
P
Posted by g_g_g_unit on November 2, 2009, at 22:30:46
In reply to Re: d-amphetamine + caffeine use in OCD - study » g_g_g_unit, posted by Phidippus on November 2, 2009, at 20:53:32
yeah there's also a study just finished up on Memantine which i was sent, though it pretty much confirms what the others have, i.e. that it's efficacious in dealing with refractory OCD.
i feel like my OCD has features of ADHD. caffeine pushes me into a really spacey headspace, but i want to try and find a doctor who will trial d-amphetamine alongside memantine.
Posted by Phidippus on November 2, 2009, at 23:41:36
In reply to Re: d-amphetamine + caffeine use in OCD - study » Phidippus, posted by g_g_g_unit on November 2, 2009, at 22:30:46
d-Amphetamine and Memantine? Lotsa dopamine in that concoction.
Are you on an SSRI? Usually docs want to do an SSRI and an atypical before they start using weird stuff for OCD.
There's lotsa of weird stuff recommended for OCD: Riluzole, Pindolol, Morphine Sulfate, Tramadol, Odansetron, Inositol, Emend, etc.
P
Posted by g_g_g_unit on November 3, 2009, at 0:40:48
In reply to Re: d-amphetamine + caffeine use in OCD - study » g_g_g_unit, posted by Phidippus on November 2, 2009, at 23:41:36
> d-Amphetamine and Memantine? Lotsa dopamine in that concoction.
>
> Are you on an SSRI? Usually docs want to do an SSRI and an atypical before they start using weird stuff for OCD.
>
> There's lotsa of weird stuff recommended for OCD: Riluzole, Pindolol, Morphine Sulfate, Tramadol, Odansetron, Inositol, Emend, etc.
>
> Punfortunately, most traditional OCD treatments didn't prove that conducive to overall functioning in me. i was working as a writer when i first began med trials and would suffer intolerable brain fog on SSRI's (not to mention word loss, more difficulty with sentence rhythms, structuring, etc.). i've wondered if my perfectionist OCD doesn't co-exist with some kind of ADHD (i've actually arranged for a screening next week). and i know it sounds weird that i'm leaping between talking about hospitalization in one thread and organizing an ADHD screening in another, but the former is more a precaution in case i become suicidal during or after Parnate withdrawal.
anyway, i kinda just dabbled in med trials til i broke down and stopped working. that's when i tried Nardil which made me giddily happy, but totally drugged out. there was one poster here who had a dramatic remission from OCD/ADHD with a low dose stim + memantine (the memantine prevented the stim from exacerbating his OCD). maybe some SRI would need to be part of the equation. i have no hope of the combo being prescribed though. i've already tried once and failed.
Posted by hopefullynow on November 4, 2009, at 0:51:25
In reply to Re: d-amphetamine + caffeine use in OCD - study » Phidippus, posted by g_g_g_unit on November 3, 2009, at 0:40:48
Hy all,
For me, SSRi's, SNRI's or TCA's cancelled the clear-minded feeling of caffeine consumption: even double-espresso's made me feel all the negative simptomps of mild intoxication (jitery, agitated,)but not the good part, that peacefully mind(again, when used with decent doses of AD's).Coffee used alone, send me in a perfect state of mind, elevated mood, clear mind, muscle tone, but after a few hours, they fade into some sort of exhaustion that push me to obtain that "normalcy" with another shot of espresso.I'm tempted to use caffeine (no stims available) with an NMDA antagonist to cancel the OCD, adhd-lke and exhaustion sansaton that comes after.Could somebody help with an list of not so common NMDA antagonists list?Amantadine maybe?Cheers all
> > d-Amphetamine and Memantine? Lotsa dopamine in that concoction.
> >
> > Are you on an SSRI? Usually docs want to do an SSRI and an atypical before they start using weird stuff for OCD.
> >
> > There's lotsa of weird stuff recommended for OCD: Riluzole, Pindolol, Morphine Sulfate, Tramadol, Odansetron, Inositol, Emend, etc.
> >
> > P
>
> unfortunately, most traditional OCD treatments didn't prove that conducive to overall functioning in me. i was working as a writer when i first began med trials and would suffer intolerable brain fog on SSRI's (not to mention word loss, more difficulty with sentence rhythms, structuring, etc.). i've wondered if my perfectionist OCD doesn't co-exist with some kind of ADHD (i've actually arranged for a screening next week). and i know it sounds weird that i'm leaping between talking about hospitalization in one thread and organizing an ADHD screening in another, but the former is more a precaution in case i become suicidal during or after Parnate withdrawal.
>
> anyway, i kinda just dabbled in med trials til i broke down and stopped working. that's when i tried Nardil which made me giddily happy, but totally drugged out. there was one poster here who had a dramatic remission from OCD/ADHD with a low dose stim + memantine (the memantine prevented the stim from exacerbating his OCD). maybe some SRI would need to be part of the equation. i have no hope of the combo being prescribed though. i've already tried once and failed.
Posted by Phidippus on November 4, 2009, at 12:46:44
In reply to Re: d-amphetamine + caffeine use in OCD - study » g_g_g_unit, posted by hopefullynow on November 4, 2009, at 0:51:25
>Could somebody help with an list of not so common NMDA antagonists list?Amantadine maybe?
* Amantadine
* Dextromethorphan
* Dextrorphan
* Ethanol
* Ketamine
* Ketobemidone
* Memantine
* Methadone
* Nitrous oxide
* Phencyclidine
* TramadolP
Posted by bulldog2 on November 4, 2009, at 13:22:33
In reply to Re: d-amphetamine + caffeine use in OCD - study » hopefullynow, posted by Phidippus on November 4, 2009, at 12:46:44
> >Could somebody help with an list of not so common NMDA antagonists list?Amantadine maybe?
>
> * Amantadine
> * Dextromethorphan
> * Dextrorphan
> * Ethanol
> * Ketamine
> * Ketobemidone
> * Memantine
> * Methadone
> * Nitrous oxide
> * Phencyclidine
> * Tramadol
>
> P
>I am going to try vyvanse again. I liked the med and found it very smooth. Unforunately I tend to build a tolerance to stimulants very quickly.
Tried memantine in the past and could not tolerate it. Even 5 mg was far to stimulating.
One ex poster need over 20 mg of memantine to get a good response.Are any tricyclic ads capable of nmda antagonism?
How much amantadine is needed for nmda antagonism?
I wonder if amantadine is easier to tolerate than memantine which really wired me up? Seriously was like super speed for me. From what I read others find it sedating.
Posted by Phidippus on November 4, 2009, at 14:35:45
In reply to Re: d-amphetamine + caffeine use in OCD - study » Phidippus, posted by bulldog2 on November 4, 2009, at 13:22:33
> Are any tricyclic ads capable of nmda antagonism?All ADs modulate glutamate.
> How much amantadine is needed for nmda antagonism?amantadine 100-400 mg/day
> I wonder if amantadine is easier to tolerate than memantine which really wired me up?Memantine is a D2 agonist which probably accounts for the wiriness. BUT, Amantadine also does this. Memantine just has a more complicated mechanism of action.
P
Posted by bulldog2 on November 4, 2009, at 14:40:15
In reply to Re: d-amphetamine + caffeine use in OCD - study » bulldog2, posted by Phidippus on November 4, 2009, at 14:35:45
>
> > Are any tricyclic ads capable of nmda antagonism?
>
> All ADs modulate glutamate.
>
> > How much amantadine is needed for nmda antagonism?
>
> amantadine 100-400 mg/day
>
> > I wonder if amantadine is easier to tolerate than memantine which really wired me up?
>
> Memantine is a D2 agonist which probably accounts for the wiriness. BUT, Amantadine also does this. Memantine just has a more complicated mechanism of action.
>
> P
>
>
>
>
>Thanks...Is there any ad that is the best as an antagonist of nmda..For some reason I recall tricyclics being mentioned but cannot find the research.
Posted by g_g_g_unit on November 4, 2009, at 16:17:18
In reply to Re: d-amphetamine + caffeine use in OCD - study » bulldog2, posted by Phidippus on November 4, 2009, at 14:35:45
>
> > Are any tricyclic ads capable of nmda antagonism?
>
> All ADs modulate glutamate.
>
> > How much amantadine is needed for nmda antagonism?
>
> amantadine 100-400 mg/day
>
> > I wonder if amantadine is easier to tolerate than memantine which really wired me up?
>
> Memantine is a D2 agonist which probably accounts for the wiriness. BUT, Amantadine also does this. Memantine just has a more complicated mechanism of action.
>
> P
>
>Memantine made me wired too at first. i liked it - i was super social, recovered my cognitive abilities, and could multi-task like nobody's business. but it also drove my compulsions out of control (as opposed to the obsessions). i guess at higher doses the NMDA effect kinda overtakes the D2 agonism, because at 20mg i became a zombie? seems like a really interesting med. just hard to dose.
Posted by hopefullynow on November 5, 2009, at 1:31:25
In reply to Re: d-amphetamine + caffeine use in OCD - study » hopefullynow, posted by Phidippus on November 4, 2009, at 12:46:44
> >Could somebody help with an list of not so common NMDA antagonists list?Amantadine maybe?
>
> * Amantadine
> * Dextromethorphan
> * Dextrorphan
> * Ethanol
> * Ketamine
> * Ketobemidone
> * Memantine
> * Methadone
> * Nitrous oxide
> * Phencyclidine
> * Tramadol
>
> P
>
Thank a lot for the extensive list.Nitrous oxide it's used in body building as supplement, right?Do you know at what dosage it exerts the NMDA antagonism?Regards!
Posted by Phidippus on November 6, 2009, at 18:03:14
In reply to Re: d-amphetamine + caffeine use in OCD - study » Phidippus, posted by hopefullynow on November 5, 2009, at 1:31:25
>Nitrous oxide it's used in body building as >supplement, right?Do you know at what dosage it >exerts the NMDA antagonism?
Nitrous Oxide is the medical aneasthetic/gas often used by dentists to sedate patients. I imagine it produces its effects at whatever range they use on the chair.
P
Posted by hopefullynow on November 7, 2009, at 1:22:54
In reply to Re: d-amphetamine + caffeine use in OCD - study » hopefullynow, posted by Phidippus on November 6, 2009, at 18:03:14
>
> Nitrous Oxide is the medical aneasthetic/gas often used by dentists to sedate patients. I imagine it produces its effects at whatever range they use on the chair.
>
> PThanks for your reply.I've confused nitrous oxide with nitric oxide, which I think is not the same.
http://www.bodybuilding.com/store/no2.html
Regards
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