Posted by phidippus on June 12, 2015, at 17:49:31
In reply to Re: Medications that don't touch the 5HT1 receptor?, posted by tiopenster on June 12, 2015, at 17:06:26
400 mg and an AD? Well, that's a fine recipe for treating GAD or OCD.
So, from your history, SNRIs and SSRIs seem to worsen your anxiety. Remeron works but makes you flat.
hmmm.
Now a review of your symptoms: panic and a free floating anxiety (feeling something is wrong) in the past. Hypochondriasm. Guilt around two things you think you've done.
I would diagnose you with GAD and OCD based on these symptoms. Hypochondriiasm and the guilt you're experiencing is definitely OCD. Panic and free floatinng anxiety may be due to the OCD but may also stem from GAD.
I would focus on treating the OCD. First, I would find a therapist who specializes in OCD and in particular, treating it with ERP. This is first line treatment for OCD. Second line treatment is a SEROTOGENIC AD. OCD entails a defecit of serotonin in regions of the brain and a surplus of dopamine in others (primarily the nucleas accumbens). SO you have to treat the lowered levels of serotonin with a serotogenic AD. IF SSRIs and SNRIs are backfiring on you, it would be best to try your alternatives: Clomipramine and Mirtazpine. You can also try Trazandone. Viibryd and Brintellix are aternatives, but you seem to think 5ht1a agonists cause you problems...Also, remember it takes higher doses of ADs to treat OCD properly. For instance, if you're taking Remeron, you'd take as much as 90 mg-dosages up to 120 mg have been reported.
To lower dopamine and if their isn't enough response to an AD, the APA recommends augmentation of an AD with an AAP (low dose). Geodon seemed to work well for you when coupled with Remeron.
SO, if you're on an AD and an AAP and you're still having issues with the OCD, the APA recommends the addition of a glutamate inhibitor. You happened upon this strategy when you were taking Remeron, Lamictal (a glutamate inhibitor) Geodon and whatever else you were on. You reported this combination helps.
Other glutamate inhibitors yo can use to treat your OCD are: Zonegran, Topemax, Riluzole, Lyrica, Keppra, Lamictal, memantine, Gabapentin...
Lyrica worked for you for obvious reasons
Now, there are other medicationns you can take to combat the OCD and they are: Tramadol, Dextroamphetamine, Caffeine, Morphine and ondansetron.
How do I know all this? I'm an OCD coach :)
Eric
ps. what are these things you are feeling guilt about?
poster:phidippus
thread:1079343
URL: http://www.dr-bob.org/babble/20150520/msgs/1079704.html