Posted by phidippus on November 4, 2014, at 19:45:58
In reply to Need thoughts as to where to go next- longer post, posted by seekinginformation on November 1, 2014, at 18:40:21
> I took 5 MGs Prozac, 50 MGs Topamax, and .5 Mgs of Klonopin for years successfully for my OCD and GAD.
You do know it takes very high doses of SSRI to treat OCD? A therapeutic dose for OCD of Prozac is 60 mg.
>It was like a miracle.
You got lucky.
> That didnt seem to hold up as well, Topamax really calmed my OCD/intrusive thoughts, and "busy mind" down. Gabapentin and NAC certainly did not...
Topamax helps with your anxiety because it antagonizes glutamate. Gabapentin should be doing the same thing if its at the right dose-about 2400 mg a day.
NAC never worked for me.
>I cross tapered over the course of a month from 5 MGS Lexapro to 10 MGS Prozac. Then as I finished up that cross taper, we added in 30 MGS of Topamax sprinkles that I titrated up on. We then decided to try to go to 50MGS of Topamax (my previous dose) via titration, and within the week, all hell broke loose!
OCD and GAD have a way of 'blooming' during certain times. I believe you were doing fine and came under some extra stress and your symptioms worsened. I don't think the med changes had anything to do with the worsening of your symptoms. What sort of stressors were you having at this time?
Also, your low doses of medication did nothing to help quell your 'bloom'. Had you been on 60 mg of Prozac, I think you would have been fine.
>Next, we increased the Prozac to 15 MGS.
Wow. You needed 45 mg more.
>we had to back off of that and go down to 10 MGS about 10 days ago.
This is not helping you. I would add propanolol 80 mg and increase your prozac to 30 mg.
>All of these changes have left me reeling, and with very little improvement.
Because you do not have ENOUGH medication in your body. I am not speaking from experience alone. Many years of studies and research indicate that OCD is treated best with higher doses than given for depression. Luvox 300 mg, Lexapro 30 mg, Zoloft 200 mg, Prozac 60 mg, Paxil 40 mg.
When augmenting an antidepressant with an anti-glutametergic agent such as Tompomax or Gabapentin, doses should be adjusted until maximum effectiveness is achieved. 300 mg of Gabapentin is a small dose to be taking for your level of anxiety. Try to get that dose into the 1000s
> Long story short, I'm an anxious mess, and I am not sure what is causing it, or how to fix it. my brain feels like swiss cheese.
Raise your dose of Prozac to 60 and Gabapentin to 1200. Add an atypical antipsychotic, like Geodon or Abilify-not too much though. Too much atypical antipsychotic can backfire and make OCD worse.
>I've been taking Benedry, and that has helped.
Benedryl has been shown to be useful in the treatment of OCD.
>she was really concerned about the Prozac EPS stuff. Hence getting the dose down was a top priority.
Wrong priorities. You can get the EPS under control with cogentin, propanalol or artane. Pindolol wwould help to and it has been shown effective in the treatment of OCD. OR switch to another antidepressant-might I recommend Clomipramine or Luvox, both which have been shown morer effective in treating OCD than Prozac.
> I am not certain what is causing all of this anxiety!No real reason. Don't waste your time reasoning out the anxiety. Welcome the OCD thoughts and don't fight them.
> .5 MGS Klonopin at night
Don't take too much of this as it can worsen OCD-it blocks serotonin receptors and your brain is fairly starved for serotonin. OCD=low serotonin, high dopamine, excess glutamate.
> I know that this is a long post, but I thought I would put my ordeal out there to see if anyone has any thoughts, or ideas as to how I can move forward and get some relief.
I've been doing the OCD, panic, anxiety thing for 16 years now. I've taken every pill under the sun and I know what works and what doesn't work.
Please let me know how you are doing.
Eric
ps. you should read this: http://www.aafp.org/afp/2008/0701/p131.html
poster:phidippus
thread:1073091
URL: http://www.dr-bob.org/babble/20141017/msgs/1073198.html