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Dr. Bob is Robert Hsiung, MD,
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Posted by Bill82 on February 2, 2015, at 10:17:30
In reply to Re: OCD Dont know where to go, posted by ed_uk2010 on February 2, 2015, at 6:58:24
Any thoughts on naltrexone? There's one study that found it to be useful. I don't think it would cause hormonal imbalances but I could be wrong
Posted by ed_uk2010 on February 2, 2015, at 11:13:41
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 2, 2015, at 10:17:30
> Any thoughts on naltrexone? There's one study that found it to be useful. I don't think it would cause hormonal imbalances but I could be wrong
Naltrexone is an opiate blocking drug. It may be helpful for impulse control disorders eg. pathological gambling, but I don't think it's normally helpful for OCD.
How are you doing today?
Posted by Bill82 on February 2, 2015, at 11:22:41
In reply to Re: OCD Dont know where to go, posted by ed_uk2010 on February 2, 2015, at 11:13:41
Yea that's what i figured. Ocd is pretty bad, drs keep canceling my opointments so just waiting really to get back to them and see what they say. I kind of think they are running out of potential things to try and are kind of fillabusting, but I could be weong( I hope I am actually haha).
Posted by Bill82 on February 2, 2015, at 11:24:50
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 2, 2015, at 11:22:41
Some new compulsions are starting to suchc as saying stop when I have bad thoughts and suddenly stopping when walking because something dosnt feel right. Weird disease
Posted by Bill82 on February 2, 2015, at 11:25:30
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 2, 2015, at 11:24:50
How are you doing recently?
Posted by ed_uk2010 on February 2, 2015, at 12:10:25
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 2, 2015, at 11:25:30
I'm not too bad thanks, things are reasonable. I have side effects from a lot of meds but not too many from SSRIs. Mind you, I have been on one or another for almost two decades, plenty of time to get used to them.
I suppose the advantage of saffron is that you can start treatment yourself. It is rather expensive though....
Posted by Bill82 on February 2, 2015, at 17:47:19
In reply to Re: OCD Dont know where to go, posted by ed_uk2010 on February 2, 2015, at 12:10:25
Glad you are feeling ok, side effects are a real pain. I just ordered some so I'll have to try it out. Have you ever heard of tianeptine?
Posted by Michael Bell on February 2, 2015, at 22:43:56
In reply to OCD Dont know where to go, posted by Bill82 on January 30, 2015, at 20:56:23
Take it from someone who had extreme hypochondriasis and obsessive/ruminative tendencies. I've been on everything. For daily medication, nothing works better than clomipramine. For anhedonia/low mood/OCD, ketamine infusions are damn near miraculous.
Posted by ed_uk2010 on February 3, 2015, at 6:36:02
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 2, 2015, at 17:47:19
>Have you ever heard of tianeptine?
Yes. I've never been on it but I am familiar with it.
Posted by Hugh on February 4, 2015, at 11:42:29
In reply to OCD Dont know where to go, posted by Bill82 on January 30, 2015, at 20:56:23
Deep TMS press release:
The double-blind, placebo-controlled study involved a total of 25 OCD patients that had previously failed to respond to both pharmacological and psychological therapy.
The clinical results showed an average improvement of 27% in symptoms of patients in the high-frequency treatment group, which was significant relative to the sham-control treated group (p=0.0003).
From Yale Daily News:
Researchers at the Yale School of Medicine studying obsessive-compulsive disorder are moving closer to personalizing treatments to individuals brains.
The researchers are the first to use functional Magnetic Resonance Imaging to predict whether neurofeedback a technique in which patients are shown a real-time graph of their brain activity while they experiment with various treatment techniques will work for certain patients. Using 13 patients, researchers found that individuals with a stronger connection between the orbitofrontal cortex, a region responsible for decision making that also becomes hyperactive when people become abnormally anxious about dirt and grime, and the rest of the brain respond better to neurofeedback.
Some people will have a certain brain pattern and respond to certain types of treatment, while others will have a different brain pattern and respond to different types of treatment, senior author and assistant professor of diagnostic radiology at the Yale School of Medicine Michelle Hampson said.
http://yaledailynews.com/blog/2014/10/21/neurotherapy-more-successful-for-some
Posted by Louisiana Sportsman on February 6, 2015, at 14:47:02
In reply to OCD Dont know where to go, posted by Bill82 on January 30, 2015, at 20:56:23
This is such a great thread!
I would suggest buprenorphine therapy, it could help. But consider Pregabalin first. Or a really slow taper of Anafranil.
Posted by Bill82 on February 7, 2015, at 3:04:59
In reply to Re: OCD Dont know where to go, posted by Louisiana Sportsman on February 6, 2015, at 14:47:02
Thanks for the responses guys, dug up some interesting info on berberine, a sigma agonist that has a lot of other benifits and seems to be anoloxcic and anti depressive. From the roots of some common plants such as barberry(gives it the yellow color). Might get some...
Posted by Bill82 on February 7, 2015, at 3:38:58
In reply to Re: OCD Dont know where to go, posted by Louisiana Sportsman on February 6, 2015, at 14:47:02
Never mind berberine is used in prostate cancer haha, will pass on it for now then!
Posted by Bill82 on February 9, 2015, at 14:13:42
In reply to Re: OCD Dont know where to go, posted by Louisiana Sportsman on February 6, 2015, at 14:47:02
This article is interesting. Although when not on an ssri I don't experience depression, it may offer insight into how I get seemingly anticholinergic side effects from ssri. Just a thought.
Posted by ed_uk2010 on February 10, 2015, at 12:16:14
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 9, 2015, at 14:13:42
Thanks for posting.
So, have you made any changes to your meds?
Posted by phidippus on February 10, 2015, at 15:48:45
In reply to OCD Dont know where to go, posted by Bill82 on January 30, 2015, at 20:56:23
First off, first line treatment for OCD is not medication, but ERP (exposure and response prevention). Its not easy to do, but if done properly, can curb even the worse ideations.
Second line treatment of OCD is treatment with a serotogenic drug. OCD involves lowered levels of serotonin in certain areas of the brain. Because of the physiology of OCD, you can't really treat it with anything else-unless you're using anti-glutamatergic drugs or antipsychotics to augment treatment with an antidepressant.
You described the medications you were on and I'm noticing a couple of trends with the antidepressants you've taken. Most or all of them caused an imbalanced emotional state: Mirtazapine, Luvox, Zoloft, Lexapro, Brintellix. This could be an indication of bipolar disorder, in which case you will need treatment with a mood stabilizer before you treat the OCD with an antidepressant.
Once you've treated the OCD with an antidepressant and you don't have the response you want, you'll want to augment with an antipsychotic (never take an antipsychotic alone to treat OCD-it'll just make it worse). The reason you want to augment with an antipsychotic is because OCD involves high levels of dopamine in certain parts of the brain, most notably the nucleus accumbens. Together the antidepressant and the antipsychotic will work together to lessen symptoms.
If you still don't have enough response to the antidepressant and the antipsychotic, it is advised that you add a anti-glutamatergic agent like Riluzole, Keppra, Zonegran, Topemax or Lyrica.
When you take antidepressants, typically, how long are you on them before you stop them because of side effects?
I too have severe OCD and have been able to conquer it with the right mix of medications and therapy. Write me back if you have any questions.
Eric
Posted by phidippus on February 10, 2015, at 15:51:37
In reply to Re: OCD Dont know where to go, posted by Bill82 on January 31, 2015, at 16:03:55
>I was about to try pregabalin but p doc decided against it die to adverse reactions to other GABA meds(benzos and lamictal).
Pregablin has nothing to do with GABA. It is a Calcium Channel blocker and glutamate antagonist. It would be ideal for treating your OCD.
Eric
Posted by phidippus on February 10, 2015, at 16:01:16
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 1, 2015, at 13:10:41
>Zoloft was at 50mg for 3 days haha.
It takes about 4-6 weeks for SSRIs to become effective.
Eric
Posted by phidippus on February 10, 2015, at 16:12:41
In reply to OCD Dont know where to go, posted by Bill82 on January 30, 2015, at 20:57:31
Have you done ERP?
Eric
Posted by Bill82 on February 10, 2015, at 18:05:01
In reply to Re: OCD Dont know where to go » Bill82, posted by phidippus on February 10, 2015, at 16:01:16
Yea they had discussed the bipolar stuff with the doc, but when I'm not on any meds at all as I am now, I don't have depression at all and have never been manic or overly attentive, irritable, creative ect. So not sure why I would treat something that dosnt exist in the first place. As for the the gabapentin, she said it not me haha, and I noticed from the begining she seemed kind of daft in terms of understanding the science. (Ex: giving the car fluid example for why you have ocd, inferring I'm running low on seritonin and it's that simple.) as for erp, I already do that on my own time but it is not enough, as when exsposing myself to the stimulus and resisting my compulsions, which I do a lot, it causes a lack of motivation and zest for life that I had before(ex: not doing my rituals I then feel like a piece of crap, I don't have any desire to do anything to) . Only residual symptom psychologically I have that I didn't have before is an inanity to pay attention to a certain task, in that I space out or get distracted, and not from my ocd, but from other things. As for the zoloft I know 3 days would do squat, but the effects I had from it made me quit early because I simply couldn't take it. But still not sure what to as ssri make me sad and blue(what they do mentally is make me brush off the thoughts and then I feel like crap similar to erp) antipsychotics as you said do nothing on their own. Really what I would like is to find away to remove some of the extreme inability to have confidence in anything, but most people say that's impossible sadly.
Posted by Bill82 on February 10, 2015, at 18:49:14
In reply to Re: OCD Dont know where to go » Bill82, posted by phidippus on February 10, 2015, at 15:48:45
And luvox month and a half maybe two, brintillex 4 months, prozac a week then rash and inability to go to bathroo so had to stop
Posted by phidippus on February 11, 2015, at 15:38:11
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 10, 2015, at 18:05:01
Suggesting you were by bipolar was just that: a suggestion. Its good that you're not.
>(Ex: giving the car fluid example for why you have ocd, inferring I'm running low on seritonin and it's that simple.)
Its not that simple, but low serotonin accounts for a majority of the problem. High dopamine and high levels of glutamate also play a big part.
>as for erp, I already do that on my own time but it is not enough, as when exsposing myself to the stimulus and resisting my compulsions
Resisting your compulsions is not really a part of ERP.
How do you do your ERP-how do you expose yourself to the stimulus?
>not doing my rituals I then feel like a piece of crap, I don't have any desire to do anything
What sort of rituals do you have?
OCD kind of works that way-it'll make you feel depressed when you don't do your rituals, but this feeling usually passes.
>Only residual symptom psychologically I have that I didn't have before is an inanity to pay attention to a certain task, in that I space out or get distracted, and not from my ocd, but from other things
Funny you should mention this, because dextroamphetamine has shown efficacy in the treatment of OCD-d-amphetamine might help your OCD and attention problems.
>what they do mentally is make me brush off the thoughts and then I feel like crap similar to erp
You basically feel guilty for not having the thoughts which makes you depressed?
>Really what I would like is to find away to remove some of the extreme inability to have confidence in anything
Does this lack of confidence come from your anxiety?
Eric
Posted by Bill82 on February 11, 2015, at 16:37:06
In reply to Re: OCD Dont know where to go » Bill82, posted by phidippus on February 11, 2015, at 15:38:11
Yea one of my obsessions is that I will become bipolar or schizophrenic so I think about it a lot...idk just want my damn life back haha
Yea I was looking at maybe a seritonin modulator instead since I get bad vocal tics on ssri.
Pretty much erp I do is I just choose not to do a compulsion and put it off until I hopefully forget about it. Problem is even if I forget about it I get triggered again.
Well might be tmi, but I have primarily sexual obbsessions, so rituals are replaying intrusive thought over and over on my mind until it feels right that I don't like it, dosnt sound too bad on paper but it has destroyed my life, unemployed havnt left my house in several months now. If I have a bad thought in shower or when I do my duty, I can get stuck doing same thing I was doing,(doing my male typical thing) which can last for at times up to 4 hours. I have scars from this sh*t it is just aweful.
Had thought of that, my doctor I see now has also written a paper about it at one time I think, I am just scared to ask because of my previous abuse of benzos and don't want to come off as a junkie and lose another doctor. Also last night I actually tried to see how caffeine would do and I had a cup of coffee which I normally don't drink. Increased focus at first but then began to give me really bad jitters and worsened ocd till I fell asleep finally at 6am haha, maybe chronic dosing would be different, coffee is also a adenosine(spelling?) antagonist I beleive so it's probably different
Feel guilty like I'm begining to accept them and will soon find it's ok and my new life will begin.
Yea I'd say so....best way I can describe it is that it's an inability to take risks for some things if that makes since. For example think of something you would literally die to protect, and then wether you would risk that in any way. It's a paradox. I also feel like I'm always lying, so for example I feel like I am making something up when I wrote this to you and am stretching the facts and that I might not have ocd etc.
My ocd was also sudden onset pretty much occurring after I caught a mycoplasma infection. Before this I had pediatric lyme and seizures that went away after antibiotic treatment for years, and I might have had obsessive tendancies, my mom remebers me reporting lo and behold intrusive sexual and violent thoughts and hypochondriac things( like worrying I has testicular cancer) at the age of 5 6 but these disappeared after age 10 when the seizures stopped. In middle and high school all I had was goal oriented obbsessions, that were ego syntonic. Ie I loved playing football so I lifted and trained for football a lot. I was always a little bit of a worrier but not at all to the extent I am now.
So part of me believes I have always had ocd other part says it may be partially be immune mediated. I try to keep them in two seperate categories, so for now I am trying ivig therapy for the immune side, and focussing most of my attention on the belief I always had ocd.
Also I was on lamictal for a long time as a child for seizures, a year or so I think, and I guess I tolerated it well then, but I was also better then, and wasn't in the state I am now. As I have sexual based ocd one of the main things I worry about is I will become impotent or have my testosterone lowered, stupid I know but then again so is my brain haha. Might be a thought for the bipolar and glutamate side of it, but worry about impotence it may cause(no effects on testosterone I exhausted the internet on that haha)
Lastly just want to thank you and everyone else for helping me it means a lot. This is one of the main things I look forward to in the day is hearing your guys thoughts.
And last thing for eric, since you seem to know a lot about ocd I had a question about yours, do you notice when you first wake up in the morning, as in the first 5 minutes it's non existent? Like if you had a bad thought before you fell asleep after waking up it dosnt seem to catch hold nearly as bad? Was wondering because I have seen others say this and I know this is true for me too. Was wondering if it's in connection to why when you have a dream, while dreaming you beleive in it, but then when you wake up you say wtf? Possibly upon arrousal certain hormones chemicals are used to create this process? Maybe this is similar to how ocd works, In that you have a bad thought and it seems like the world is ending, you successfully delay thinking about it, 20 min later you look back and say ahh that was horse... I know this to be true at least with past obbsessions of mine too, like my hands sweating or that I had als, look at those thoughts now and say lol. Anyways thanks for your thoughts means a lot, also if this dosnt make since just let me know and I'll try to explain better.
Posted by phidippus on February 11, 2015, at 17:20:41
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 11, 2015, at 16:37:06
> Yea one of my obsessions is that I will become bipolar or schizophrenic so I think about it a lot...idk just want my damn life back haha
How old are you? If you're under 30 it could happen. Now there's some ERP for ya.
> Yea I was looking at maybe a seritonin modulator instead since I get bad vocal tics on ssri.
Seritonin modulators don't work very well for OCD. Do you think these ticks might be psychosomatic?
> Pretty much erp I do is I just choose not to do a compulsion and put it off until I hopefully forget about it.
That isn't ERP. ERP deals with the obsessive thoughts you have.
> Well might be tmi, but I have primarily sexual obbsessions
I have intrusive thoughts about molesting children, mostly those children related to me.
>so rituals are replaying intrusive thought over and over on my mind until it feels right that I don't like it
This is not a ritual, but an obsession.
>dosnt sound too bad on paper but it has destroyed my life,
Writing down obsessions is usually ineffective as a therapy, however recording your thoughts on audio and playing them back to yourself is a method of ERP.
>unemployed havnt left my house in several months now.
How do you subsist?
>If I have a bad thought in shower or when I do my duty, I can get stuck doing same thing I was doing,(doing my male typical thing) which can last for at times up to 4 hours. I have scars from this sh*t it is just aweful.
Am I to understand you masturbate for hours on end? That's more like an addiction.
>Also last night I actually tried to see how caffeine would do and I had a cup of coffee which I normally don't drink.
Studies show caffeine lessens the symptoms of OCD, but you need doses as high as 200 mg.
> Feel guilty like I'm begining to accept them
This is a common sentiment among sufferers of OCD. Thing is, you're not accepting the thoughts-you're reducing their power to frighten you. You're never going to accept the thoughts, but you don't need to have so many and they don't need to rule you.
>I also feel like I'm always lying, so for example I feel like I am making something up when I wrote this to you and am stretching the facts and that I might not have ocd etc.
You tryuly are a Doubting Thomas. So what if you're lying?
> So part of me believes I have always had ocd
Some are born with OCD and others develop it, like me.
>
> As I have sexual based ocd one of the main things I worry about is I will become impotent or have my testosterone lowered, stupid I know but then again so is my brain haha.If you want to try some ERP, when you have thoughts like those, agree with them. Tell yourself you will become impotent. Do things to purposefully become impotent-like stick your crotch against the microwave.
>do you notice when you first wake up in the morning, as in the first 5 minutes it's non existent?
Yes I do.
>Possibly upon arrousal certain hormones chemicals are used to create this process?
Not hormones. OCD is a neurochemical process.
>Maybe this is similar to how ocd works, In that you have a bad thought and it seems like the world is ending, you successfully delay thinking about it, 20 min later you look back and say ahh that was horse...
Ideally, you don't want to delay thinking about it. You don't want to suppress the thought. Enjoy the thought, I dare you.
Eric
Posted by ed_uk2010 on February 11, 2015, at 17:27:12
In reply to Re: OCD Dont know where to go, posted by Bill82 on February 11, 2015, at 16:37:06
>I also feel like I'm always lying, so for example I feel like I am making something up when I wrote this to you and am stretching the facts and that I might not have ocd etc.
That's very typical of OCD. They're often called 'obsessions of doubt', as you probably know.
>one of the main things I worry about is I will become impotent or have my testosterone lowered, stupid I know but then again so is my brain haha.
Sexual obsessions are common in OCD - and distressingly difficult to discuss.
I believe you need to practice 'acceptance'. Accept your obsession.... it's OK that you may have lowered testosterone. Although I expect your testosterone is perfectly normal, what would happen if it was low? Nothing serious really. If it was low at any point you could be prescribed testosterone replacement and you'd be fine. The consequences of having low testosterone would be far less severe than the consequences of OCD.
And the impotence. Accept it. Again, it's highly unlikely you have any medical reason for being impotent at your age. But most men would struggle to get an erection if they were in a state of psychological distress. So if you do experience distress, you may struggle too. But accept it. What are the consequences of not getting an erection? Again, they are less severe that the consequences of OCD. Having an erection isn't much benefit when you've got severe OCD. And think... millions of people live with erectile problems caused by medical disorders. Any erectile problems you have will be temporary and psychological. If you accept that you may be temporarily impotent when under stress, you would do yourself a favour. Most men would not get an erection when under immense stress. This is perfectly normal. The more you accept this is a normal feature of being a man the less anxiety you'll have.... and then you won't have a problem with erections anyway. Even if you did, it's not life-threatening, and it's treatable. So perhaps.... just think 'well, what if I was impotent?' What if you were? You'd still be here. You could be treated, you could live a happy life. Much happier than you are right now. Impotence is generally a lot easier to treat than OCD!
If I don't get an erection it normally means I'm not in the mood. I'm not always in the mood. A lot of people aren't. It doesn't imply a major problem, I'll be in the mood another time.
Sometimes, it's not possible to force the thoughts out of your head until you've considered..... are the consequences of the obsessions really as bad as the obsessions themselves? They almost never are. It would be easier to be impotent and not have OCD. It could be treated more easily. Hopefully, if you think this to yourself, the obsessions will reduce and you'll realise you don't actually have an erectile problem either.
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