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Re: Djmmm! YOU ARE A GENIUS! More qstns.

Posted by djmmm on March 27, 2003, at 17:27:24

In reply to Djmmm! YOU ARE A GENIUS! More qstns. djmmm, posted by ace on March 26, 2003, at 18:51:47

> > > Hi Djmmm,
> > >
> > > Thankyou for your earlier responses. At the moment my Lithium augmented with Nardil has not relieved OCD (only 7 days on Lithium 2 days-250mg, 5 days 500mg)
> > >
> > > If the Lithium doesn't work I am really thinking that their could be a significant problem with dopaminergic transmission underlying my OCD. And this brings me to Zyprexa and Risperidone. As Dopamine antagonist (& they are serotonin agonists I've heard -at least for Zyprexa) I've heard that in augmentation with serotoninergic drugs they have produced a lot og great effects - some extrodinary.
> >
> > There is some evidence that OCD is highly genetically based, and that both serotonin and dopamine play important roles. Specificallly the D1, D2 and D4 receptors.
> > >
> > > Do you think Nardil + Lithium + Zyprexa (OR Risperidone) would be a good bet (or drop the Lithium?)
> >
> > Zyprexa is worth a try...you may want to consider something like Tegretol (which I have combined with Nardil in the past). Tegretol has anti-OCD properties...You may also want to consider cognitive behavioral therapy, CBT could be just the right therapy to get you OCD free.
> >
> > > Do you believe, as I have reasoned, there very well could be a dopamine problem behind my OCD?
> >
> > Yes, there is a lot of evidence for a strong dopamine component to OCD
> >
> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11770060&dopt=Abstract
> >
> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11269909&dopt=Abstract
> >
> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11147933&dopt=Abstract
> >
> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10920469&dopt=Abstract
> > >
> > > Any other comments most appreciated.
> > >
> > > BTW, clomipramine enhances noradrenaline, but we have that 'covered' with Nardil, right?
> > >
> THAT is exactly what I thought. Essentially we have potent serotonin and noradrenaline agonism with clomipramine - but we have exactly the same with Nardil, albeit in a different way (the inhibition of MAO enzymes). I though this all along and no one listened. Thanks so much for confirming Djmmm!
>
> It look like the Lithium, after 1 weeks and 2 days is not helping. I am skeptical it will. I think it is time indeed to look at dopamine antagonism - would you agree? BTW, does Nardil have as strong effects on serotonin as clomipramine?


> I'm thinking now Djmmm, if Lithium is helping, another serotonin agonist is unlikely to help...I think I'm best to head straight to the dopamine antogonists (1. Bromocriptine (first, because of No EPS risk) 2. Zyprexa, 3. Risperidone). My doctor is a bit sour on Tegretol, but I'll have a good chat to him.

Try and stick with the Lithium for a bit longer, give it a month at a high dose....Bromocriptine is a dopamine agonist, it's an ergot derivative, so that wouldn't help. You could try Zyprexa, or even something like Trazodone, or Seroquel... studies suggest that drugs with a high affinity for the D2 receptor, RATHER than the serotonin system, show a greater degree of anti-OCD response. Although other AP's fit this profile better, Zyprexa would still be a good overall choice. Before you move on to zyprexa, try various Benzos and anticonvulsants.


> Once again Djmmm - you are a extremely helpful member of this site. Your reply here confirmed something I couldn't get confirmed for ages.
> Your suggestions are invaluable.


Thanks Ace, I appreciate that comment.

> I look foward to your next response. (BTW, I am soon to embark on a psychopharmacology unit within my uni studies - I LOVE Chemistry!)
>
> Take Care friend,
> Ace.
>
>
>
>
> > > Thanks, Djmmm.
> > >
> > > Ace,
> >
> >
>
>


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