Posted by Cindy W on September 2, 2000, at 21:59:15
In reply to Re: Is Serzone evil? » Cindy W, posted by Adam on September 2, 2000, at 14:47:04
> Hey, Cindy,
>
> No problem. I'm terribly sorry to hear about your mother, and hope her recovery is swift. Take care of yourself, and try really hard to keep busy with brainless activities like exercise, things that keep you focused on something emotionally neutral and burn a lot of energy, which will help you relax. I've always found strenuous exercise helps me cope with lots of emotional stress and general anxiety. Stay away from caffeine and don't be afraid to sip at a glass of wine occasionally to smooth out the edges, being very conscious of course to do this in great moderation (you don't want alcohol to become your drug of choice) and keeping all drug restrictions in mind.
>
> I should qualify my statements about drugs and their effects on NE to say that, at least in some parts of the brain, NE is actually secreted more with chronic SSRI use. However, there seems to be some modified signalling that can down-regulate the effects of NE. Again, I guess the key concept is "balance" or "normalization" of NE and DA systems via enhanced serotonin signaling, with stimulation at the 5-HT2C receptor an important component, though almost certainly not the only component. Whatever is going on, NE reuptake inhibition isn't part of the equation, it would seem. There are complicated reasons for the modified sensitivity to NE, from receptor-mediated effects to ion channels and effects on circulation that I am just starting to get a handle on. In fact, desipramine, which is almost exclusively a NE reuptake inhibitor (ignoring the anti-histaminergic, cholinergic-muscarinic stuff) makes a great active placebo in a clomipramine trial for OCD. Though a metabolite of clomipramine is an NE reuptake inhibitor, the parent compound is almost exclusively (and very potently) acting at the serotonin transporter.
>
> At any rate, again, it seems the best drugs for OCD, after a good ten-or-so years now, are still the SSRIs. Some people say SSRIs are superior to clomipramine, some say just the opposite. The SSRIs are certainly easier to take. In general the SSRIs are thought to be superior to venlafaxine for OCD, though for comorbid depression, there's more to consider, obviously. Augmentation strategies, again, are many. I seem to be seeing lots of good things about low dose (the dose is very important) risperidone, to repeat that one option. Though in general addition of a neuroleptic is thought to be most helpful for those with tics, a recent small, placebo controlled trial of risp.+SSRI showed promise for some refractory to SSRI alone, and there was no obvious cluster of symptoms that responded best. That's good news for some, since I think low-dose risp. is relatively easy to take.
> Others I forgot to mention are pindolol and buspar augmentation, which seem to help some, depending on who you ask.
>
> It's all very complicated. You can find, in the literature, examples of even nefazodone or mirtazapine helping people with OCD (though, mechanistically, this doesn't make sense - beware the mechanism - but don't forget it), as well as imipramine and amitryptiline (so-called tertiary amine TCAs, which include clomipramine, all having a fair amount of serotonergic activity). Those other TCAs have only about half the life-span or less of clomipramine, though.
>
> An uncommon monotherapy is an MAOI, usually phenelzine or tranylcypromine (the former being great for social phobia), though those seem to have limited efficacy for OCD in general. For those who are helped, comorbid depression is usually a big factor, which complicates interpretation considerably.
>
> Well, I hope I got all of this right. Again, trust your doctor over all. Where do you live? I might be able to find out about CBT specialists in your area if I can tap the vine properly. CBT for OCD is my personal favorite as an addition to drug therapy. It's potent, it lasts longer, it has applications outside of the disorder, and it has NO side effects.
>
> Best of luck to you, and again, best wishes to your mother.
>
> Adam
>
>
> > Adam, thank you for the information about Serzone and Effexor-XR! Am not sure yet what to try. Have read all the behavior therapy stuff and have tried doing it; haven't found locally a behavior therapist who is familiar with OCD. My pdoc has some familiarity with OCD and is a good psychiatrist and good with meds, I think. But the Effexor-XR is definitely starting to not work for me (the more my anxiety increases, the more I start relapsing, counting, checking, hoarding, etc.). Just found out today that my Mom has lung cancer that metastasized to her spinal cord; so my anxiety is pretty well at maximum. Sounds like an OCD three day weekend to me!--Cindy WAdam, thank you for your kind post and your concern! Am waiting to see what they decide about my Mom. My family suggested I wait a few days before I come visit (5-6 hour drive each way). Will ask my pdoc about the meds you suggest, when I see him on the l8th. I do know the Effexor-XR isn't helping recently, since my home, car, and office look like landfills. Haven't found a CBT therapist locally (I live in San Luis Obispo, California); the closest I could find were in Los Angeles and San Francisco, although some pdocs (psychiatrists) as close as Santa Barbara treat OCD (with meds of course). Am trying not to go crazy, and am trying to sleep, eat, drink water, and not go crazy. (I don't drink wine; it doesn't mix with AD's and I have never cared for alcohol even before I took AD's). Again, thank you!--Cindy W
poster:Cindy W
thread:44037
URL: http://www.dr-bob.org/babble/20000822/msgs/44321.html